Follow-up barium study after a negative water-soluble contrast examination for suspected esophageal leak: is it...

Area of Science:

• Radiology
• Pediatric Imaging
• Gastrointestinal Imaging

Background:

• Esophageal injuries and leaks require prompt diagnosis.
• Water-soluble contrast esophograms are often the initial imaging modality.
• The utility of a subsequent barium esophogram after a normal water-soluble study is debated.

Purpose of the Study:

• To evaluate the diagnostic value of a follow-up barium esophogram after a normal initial water-soluble contrast esophogram in pediatric patients.
• To determine if barium esophograms add diagnostic information for esophageal injury or leak detection.

Main Methods:

• Retrospective review of pediatric patients (<18 years) undergoing both water-soluble and barium esophograms.
• Analysis of diagnostic yield for esophageal injury or leak over a 9-year period (2005-2014).
• Inclusion criteria focused on patients with suspected esophageal injury due to pneumomediastinum, trauma, or foreign body ingestion.

Main Results:

• Out of 49 pediatric patients, 46 showed negative results on both esophogram types.
• Two patients had positive findings on both water-soluble and barium studies.
• One patient had a leak detected only on the water-soluble study; the barium study was normal, indicating 100% sensitivity for water-soluble contrast.

Conclusions:

• A single water-soluble contrast esophogram is highly sensitive (100%) and has a high negative predictive value for diagnosing esophageal injury or leak.
• Follow-up barium esophograms after a normal water-soluble study do not improve diagnostic accuracy.
• Routine use of follow-up barium esophograms increases study time and radiation dose without added benefit.