GI Radiology > Esophagus > Foreign Bodies

Food Impactions & Foreign Bodies in the Esophagus (cont.)

Esophagography (examintion with contrast agent)
  • Should be employed if clinical suspicion of an esophageal foreign body is high and preliminary plain films are negative.
  • Is performed to determine whether a nonopaque foreign body is present, to define its nature and location, and to verify or excluded esophageal perforation or stricture.
  • A water-soluble contrast medium (e.g., MD-Gastroview, Mallinckrodt, Inc., St. Louis, MO) is the preferred initial contrast agent for two reasons:

    1. In cases of suspected esophageal perforation, it minimizes complications from contrast leakage into the mediastinum or pleural space (3).
    2. If noninvasive methods of removal fail and endoscopy is necessary, it is easier for the endoscopist to see through a transparent iodinated contrast medium than through opaque barium (6,8). One should be aware, however, that fatalities have occurred following aspiration of ionic water-soluble agents.
  • If aspiration is a concern, consider using either a dilute suspension of inert barium sulfate or a water-soluble, nonionic contrast agent, such as iohexol (Omnipaque 300, Amersham Health Inc., Princeton, NJ), because of their minimal reactivity in the lungs (3,8).
  • At present, the high cost of nonionic agents prohibits their routine use in esophagography (3); however, barium is relatively inexpensive.
  • About 25% of perforations will be missed by using a water-soluble agent only (22, 23). Therefore, if no perforation is demonstrated using a water-soluble contrast medium, the esophageal study should be repeated immediately with dilute barium sulfate.