Technique Dynamic Recording Esophagus (Barium Studies)

Technique
Dynamic Recording Videopharyngography, also called modified barium swallow, is an established technique providing dynamic recording in evaluating deglutition. Continuous image detection rather than pulsed fluoroscopy is preferred because transient laryngeal penetration is more difficult to detect with the latter.
Esophageal videofluoroscopy (videoesophagography) is preferred by some radiologists to evaluate esophageal tonicity and peristalsis, while most simply rely on fluoroscopic observation. Especially in a search for subtle peristaltic abnormalities, a recumbent patient position is preferred to eliminate gravity. Manometry and esophageal videofluoroscopy agreed 100% in a setting of normal esophageal function, in 90% for nonspecific motility disorders, 100% in diffuse esophageal spasm, and 90% in achalasia,but only in 50% for a “nutcracker” esophagus A computer program can quantify esophageal wall motion using data obtained from an esophagogram, but whether such information is of clinical relevance remains to be established.
Speech therapists and some radiologists prefer a lateral view when evaluating swallowing. Nevertheless, a frontal view has much to  offer during the pharyngeal phase. In experienced hands, laryngeal penetration is just as readily detected in a frontal position and, in addition, right- and left-sided pharyngeal muscle function can be compared to each other. Oblique views are of occasional value. High-speed magnetic resonance imaging (MRI) also evaluates dynamic deglutition (MR pharyngography), but clinical application of this technique is still evolving. but is useful in detecting a subtle esophageal narrowing. The tablet is designed to dissolve and thus is retained only temporarily proximal to a stricture. Normally the barium tablet should pass into the stomach within 20 seconds when using a standardized 45-degree incline position and ingesting 60 cc
of water after swallowing the tablet; failure of tablet passage under these conditions suggests a persistent narrowing. These conclusions do not apply to a patient in a horizontal position.
A barium tablet has been used to screen for occult esophageal lesions during routine chest radiography but is rarely practiced today. A chewed barium tablet, barium-impregnated marshmallow bolus, and similar contrast have been largely supplanted by standardized meals in evaluating oral and pharyngeal dysfunction.
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