Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-The Esophagram From A to EoE

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The document is a presentation outline by Dr. Mike Olson, an Assistant Professor of Radiology at the Mayo Clinic, covering the use and methodology of double-contrast barium esophagrams to evaluate various esophageal conditions. The learning objectives highlight understanding the procedural steps and identifying conditions that benefit from esophagography as a complement to endoscopy. <br /><br />The presentation details the steps involved in conducting a double-contrast esophagram, beginning with gathering a brief patient history, including any relevant surgical or procedural background, and establishing whether the patient experiences dysphagia or odynophagia with solids or liquids. The procedure involves the patient ingesting effervescent crystals with water to create gaseous distension, followed by multiple positioning instructions to optimize imaging of the esophagus for evaluating morphology, motility, and potential pathologies such as achalasia or eosinophilic esophagitis.<br /><br />Specific patient positions during the exam include Upright Left Posterior Oblique (LPO) for mucosal views, Recumbent Right Lateral for gastric fundus imaging, Right Anterior Oblique for peristalsis and distal esophagus evaluation, and finally, an Upright Anteroposterior position for assessing functional narrowing with a barium tablet. The procedure also assesses post-surgical complications, leaks, or fistulas, using water-soluble or thick barium contrasts as necessary.<br /><br />Special considerations during esophagography include the evaluation of conditions such as achalasia—characterized by absent peristalsis, tapered distal narrowing, and incomplete sphincter opening—and eosinophilic esophagitis, identified by esophageal strictures, narrow luminal diameter, and "ringed esophagus." Post-procedural complications and interventions are also discussed, emphasizing esophagography's role in assessing the Roux-en-Y gastric bypass and related anatomical complications.<br /><br />The presentation concludes with a question and discussion session.

Asset Subtitle

Michael Olson, MD

Keywords

double-contrast esophagram

barium esophagram

esophageal conditions

dysphagia

achalasia

eosinophilic esophagitis

esophagography

endoscopy

Roux-en-Y gastric bypass

Mayo Clinic