Advanced Practice Provider EoE Program (Live/Virtual) | October 2025-The Esophagram From A to EoE

The Esophagram From A to EoE

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This presentation by Dr. Mike Olson, Assistant Professor of Radiology at the Mayo Clinic, provides an overview of the double-contrast barium esophagram, highlighting its technique and clinical applications. The esophagram is an important radiologic exam used to evaluate esophageal morphology, motility, and caliber, often complementing endoscopic findings.<br /><br />The procedure involves several carefully sequenced steps:<br />- Patient history is reviewed, focusing on symptoms like dysphagia or odynophagia and prior surgeries.<br />- The patient ingests effervescent crystals with water to produce gaseous distention.<br />- Imaging positions include upright left posterior oblique (LPO) to separate the esophagus from the spine for detailed mucosal views, right lateral recumbent for the gastric fundus and cardiac rosette, right anterior oblique to assess peristalsis and distal narrowing, as well as supine and upright anteroposterior views to monitor for reflux and functional strictures.<br />- A 13-mm barium tablet swallowed whole can help evaluate esophageal narrowing.<br /><br />Specific conditions reviewed include achalasia, characterized by absent primary peristalsis, a dilated esophagus, and a tapered distal narrowing; the esophagram is useful in assessing sphincter function and treatment efficacy. Eosinophilic esophagitis shows smooth strictures, diffuse narrowing, and distinctive mucosal rings, which are well visualized on esophagography and helpful for monitoring disease progression.<br /><br />The exam is also valuable postoperatively, especially for detecting leaks or fistulas using water-soluble contrast. In patients with Roux-en-Y gastric bypass, esophagrams excel at evaluating the gastric pouch and anastomosis, outperforming CT for identifying fistulas or strictures.<br /><br />The session emphasizes the role of double-contrast esophagrams as a dynamic, informative test that complements endoscopy in diagnosing and managing esophageal diseases.

Keywords

double-contrast barium esophagram

esophageal morphology

esophageal motility

dysphagia

achalasia

eosinophilic esophagitis

radiologic imaging techniques

postoperative esophageal evaluation

Roux-en-Y gastric bypass assessment

esophageal strictures