A Modified Technique for Non-fluoroscopic Contrast Swallow in Younger Children Presenting in Resource Limited Setting

Contrast swallow (CS) under fluoroscopic guidance remains an important investigation in exploring functional and structural oesophageal disorders. However, paucity of functional fluoroscopic machines in most secondary/tertiary hospitals and diagnostic centres in Nigeria makes the investigation less popular. Commendably, many radiologists currently improvise static X-ray machines to produce "non-fluoroscopic" CS spot images useful in investigating structural oesophageal pathologies. Unfortunately, both fluoroscopic and static CS are often limited in younger children by sub-optimal positioning with attendant risk of aspiration in the uncooperative minor.

This manuscript presents a simple modified technique for diagnosing structural oesophageal lesions in younger children using the regular over-table X-ray machine angulated 30° cranially, while the child is positioned in 30° semi-recumbent position on a wedged imaging plate for additional comfort and stability. Flavoured contrast agent was then given in the same position and spot images were obtained. CS images/reports of younger children (≤6 years) conducted by a consultant radiologist over a 3-year period using the aforementioned technique were also reviewed.

The 22 retrieved cases of CS included children with median age of 2.0 years. The most common indications were postoperative assessment of surgical correction (45.5%) and dysphagia following corrosive substance ingestion (31.8%). Corrosive oesophageal stricture (29%) was the most prevalent oesophageal structural abnormality reported. All the studies produced clear spot images with conclusive diagnostic quality.

Although not previously reported in published English literature, non-fluoroscopic CS in semi-recumbent position is helpful in assessing structural oesophageal abnormality when fluoroscopy is unavailable.