Esophageal radiography

Patient preparation for the examination

The quality of radiological visualization directly depends on proper patient preparation. Since the examination of the esophagus is inextricably linked with the evaluation of the stomach, the following strict rules must be followed:

• 2–3 days before the scheduled procedure, the patient should switch to a specialized diet.
• Foods that stimulate gas formation are completely excluded from the diet. These include fresh milk, legumes, cabbage, and other fresh vegetables. This measure is critically important to prevent flatulence, as gas accumulation creates artifacts and significantly impedes the visualization of organ contours.
• The examination is performed strictly on an empty stomach.

Standard procedure methodology

During the diagnostic procedure, the patient is offered a special contrast mass to drink — a barium sulfate suspension.

The further course of the procedure is monitored by the physician using real-time fluoroscopy:

1. The physician observes the passage of the contrast through the esophagus and evaluates the subsequent filling and emptying of the stomach.
2. The most important condition for high-quality diagnostics is multi-positioning. The patient is asked to change body position, and images are taken in various projections.
3. The multi-position approach allows the mucosal folds to be straightened out, and all walls and segments to be examined in detail. This eliminates so-called summation artifacts (shadow overlapping) and prevents missing pathological processes hidden in a single projection.
4. During fluoroscopy, the physician takes spot radiographs of suspicious areas (deformation zones, radiological "niches", filling defects).

Image evaluation is performed in two modes. First, the mucosal relief is evaluated (upon swallowing a small amount of contrast that "coats" the folds). Then, the full-filling pattern of the organ is studied, which provides information on its shape and contours.

Timed barium esophagogram (TBE)

For a number of conditions, particularly when achalasia cardiae (AC) is suspected, a specialized TBE (timed barium esophagogram) technique is used. The recommendation grade for this method is A, and the evidence level is 1.

Features of the TBE technique:

• The procedure is similar to a standard barium suspension study, but measurements are taken at strictly fixed time intervals: images are taken 1, 2, and 5 minutes after barium ingestion.
• On the obtained radiographs, the physician measures the height and width of the remaining contrast column.
• The main advantage of TBE is that the method allows for the most objective assessment of esophageal emptying, unlike standard fluoroscopy.

The TBE technique is actively used for primary differential diagnosis and to monitor treatment efficacy (e.g., after balloon dilation or myotomy).

Routing and quality criteria

Radiography is part of a comprehensive examination. Primary care physicians (general practitioners, family doctors) refer the patient to a gastroenterologist when pathology is suspected.

The diagnostic complex (organized on an outpatient basis or in a day hospital) includes:

• Esophagogastroduodenoscopy (EGD).
• Barium fluoroscopy (including TBE).
• Esophageal manometry (high-resolution, if possible).

After confirmation of the diagnosis, the patient is routed to a surgical hospital.

Criteria for assessing the quality of medical care:

Class and exam questions

What else to study on this topic

• Radiological signs of filling defects and "niches"
• High-resolution esophageal manometry: technique and indications
• Endoscopic research methods (EGD) in differential diagnosis
• Tactics of surgical and endoscopic treatment of achalasia cardiae
• Summation artifacts in diagnostic imaging: causes and prevention

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.