​Clinical Procedures - Barium Swallow/Barium Meal

​Clinical Procedures - Barium Swallow/Barium Meal
Barium swallows examine the oropharynx, oesophagus, and GO]; barium meals examine the stomach and first part of the duodenum. They are often performed together as described below.
Indications
• Investigation of esophageal and gastric pathology. Indications include dysphagia, odynophagia, dyspepsia, weight loss, anaemia, epigastric mass, partial obstruction
• I Always consider alternatives (e.g. OGD, MRI).
Contraindications
• Absolute: lack of informed consent, complete bowel obstruction, suspected perforation (a water-soluble contrast may be used instead)
• Relative: a large degree of patient cooperation is required so those unable to understand or follow instructions are unsuitable. Also, the patient must be able to stand for the duration of the examination and to lie supine if necessary.
Procedure
The patient drinks barium whilst the esophagus and stomach are imaged fluoroscopically. Usually performed by a radiologist.
• The patient stands in the fluoroscopy machine
• A gas-producing agent is ingested (e.g. Carbex®) and the patient is asked not to belch
• Images are taken as the patient swallows mouthfuls of barium. The patient must be able to hold the liquid in their mouth and swallow on command
• Once views of the esophagus have been obtained, the machine is tilted so the patient is supine. The patient is instructed to roll and tilt as images of the stomach are obtained from several angles:
• This requires a certain degree of patient fitness
• The time taken depends to a degree on how easily the patient follows the commands, although usually lasts 15-20 minutes
• After the procedure, the patient may eat and drink as usual but is advised to open their bowels regularly to avoid barium impaction.
Risks
• Leakage of barium through an unsuspected perforation:
• Intraperitoneal and intramediastinal barium has a significant mortality rate
• Barium impaction (causing large bowel obstruction) or barium appendicitis.

Patient Preparation
• Fasting: nil by mouth for 6 hours before the examination
• Bowel preparation: none required
• Smoking: patients are asked not to smoke for 6 hours before the procedure as this increases gastric motility.
Other Information
• A barium study will prevent a CT examination of the same area for a period of time as intestinal barium creates dense streak artefact.
Water-Soluble Contrast Examinations
• In the case of recent surgery, suspected perforation, or investigation of a leak, water-based iodinated contrast is used instead of barium.
Examples include Gastrografin®, Urografin®, Niopam®, Omnipaque®
• A single-contrast examination is performed (i.e. the gas-producing agent is not given and many of the 'standard' views are not included
• In contrast to the barium examinations, these studies can be carried out on patients who are frail and/or have recently had surgery
• Intraperitoneal or intramediastinal water-soluble contrast does not carry the risks of barium but aspiration of the contrast can result in pulmonary edema and lung fibrosis. Hypersensitivity is also a risk.