Food Impactions & Foreign Bodies in the Esophagus (cont.)
Esophagography (examination with contrast agent)
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- 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 non-ionic water-soluble contrast medium is the preferred initial contrast
agent for two reasons:
- In cases of suspected esophageal perforation, it minimizes
complications from contrast leakage into the mediastinum or pleural
space (3).
- 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.
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