Is iohexol an acceptable alternative to barium sulphate for videofluoroscopy swallowing studies? An observational...

Videofluoroscopic swallowing studies traditionally use barium sulphate and remains the gold standard for evaluating swallowing disorders. Due to a global shortage, this study investigates the acceptability of iohexol as an alternative.

An observational mixed-method study in a quaternary hospital. Speech-language pathologists rated 294 swallows across 70 videofluoroscopic swallowing studies on a 5-point Likert scale assessing visibility, while blinded to the contrast used (barium or iohexol). Speech-language pathologists experienced with both agents also completed a qualitative online survey on contrast acceptability. Both data types were given equal weight in analysis.

Fifteen Speech-language pathologists (mean years of experience 6.87, SD = 5.33) completed visibility ratings; 11 completed the acceptability survey. Acceptability was found to be consistency dependent with iohexol preferred for thin fluids; yet acceptability was also influenced by contrast availability, taste, preparation time, and effort, as well as patient aspiration risk. When blinded to the contrast used, speech-language pathologists were more often satisfied with barium (odds ratio 0.51, 95% CI 0.46-0.58); however, for fluids alone, iohexol was rated more satisfactory (odds ratio 1.26, 95% CI 1.07-1.49).

Barium sulphate remains preferable for visibility and preparation, but iohexol was also acceptable, particularly for fluids and in situations where barium is unavailable.