RadteraEsophagram (Barium Swallow)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Dysphagia
- Odynophagia
- Suspected stricture, web, or ring (e.g., Schatzki ring)
- Gastroesophageal reflux / hiatal hernia
- Suspected esophageal mass or carcinoma
- Achalasia or other dysmotility
- Suspected perforation or leak (use water-soluble)
- Evaluation of varices
- Postoperative anastomotic evaluation
Patient prep
- NPO at least 4-6 hours (commonly NPO after midnight)
- Remove radiopaque objects from neck/chest
- Confirm no recent suspected perforation before giving high-density barium
- Screen for aspiration risk and barium allergy/prior reactions
Contrast
AgentHigh-density barium sulfate suspension for double-contrast; thin (low-density) barium for full-column/motility; water-soluble iodinated (e.g., Gastrografin or low-osmolar Omnipaque) if perforation/leak suspected or aspiration risk
Routeoral
DoseVariable per swallow; effervescent granules/gas crystals for double-contrast distention
TimingReal-time fluoroscopic observation during swallowing and esophageal transit
Technique
- Begin upright; have patient drink barium while imaging the pharynx and esophagus
- Double-contrast: effervescent crystals then high-density barium, upright LPO/RPO for mucosal relief
- Single/full-column: thin barium with patient prone RAO to distend and assess contour and motility
- Mucosal relief views after column empties
- Prone RAO bolus-swallow for primary peristalsis/motility (single swallow)
- Provocative maneuvers for reflux/hernia: Trendelenburg, Valsalva, water-siphon test
- Solid bolus (marshmallow, barium tablet, or bread) to unmask subtle rings/strictures
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Pharynx during swallow | AP and lateral | Spot or rapid-sequence/video for pharyngeal phase |
| 2 | Cervical esophagus | AP and lateral | Webs, Zenker, cricopharyngeal bar |
| 3 | Double-contrast esophagus | Upright LPO/RPO | Mucosal detail, distention |
| 4 | Full-column esophagus | Prone RAO | Contour, strictures, varices |
| 5 | Motility single-swallow | Prone RAO | Primary peristalsis |
| 6 | GE junction / fundus | Prone RAO / upright | Hiatal hernia, reflux, Schatzki ring |
| 7 | Reflux maneuvers | Supine/Trendelenburg | Water-siphon, Valsalva |
Key points
- Use water-soluble iodinated contrast first if perforation/leak/postoperative anastomotic leak is suspected; if water-soluble is negative and suspicion persists, follow with barium for better sensitivity
- Avoid high-osmolar water-soluble agents (Gastrografin) if aspiration risk is high (chemical pneumonitis/pulmonary edema); use low-osmolar nonionic agent instead
- Barium is contraindicated if free peritoneal/mediastinal leak likely (barium mediastinitis/peritonitis)
- Solid bolus challenge increases sensitivity for rings and strictures
- Distinguish from MBSS: esophagram focuses on the esophagus; MBSS is the dynamic swallow study with speech-language pathologist
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.