Esophagrams have a slightly lower sensitivity and substantially higher specificity compared with CT for detecting leaks after esophagectomy [41]. Fluoroscopy Biphasic Esophagram Biphasic esophagram is not usually indicated when a patient has dysphagia in the immediate postoperative period. Single-contrast technique utilizing water-soluble contrast is preferable because evaluation for postoperative leak is the primary concern. Fluoroscopy Barium Swallow Modified When oropharyngeal dysphagia occurs postoperatively and there is a high index of suspicion for swallowing dysfunction, a modified barium swallow is the study of choice, especially if leak has been excluded clinically or with imaging. In the immediate postoperative period, if a leak or perforation is of clinical concern, a single-contrast esophagram with water-soluble contrast may be more appropriate because it is better suited to evaluate postoperative structural abnormalities. However, a modified swallow performed with water-soluble contrast material has been shown to be effective in the diagnosis of leakage [41]. In this study there were no adverse events associated with aspiration of iohexol as water-soluble contrast material [41]. A modified barium swallow examination does not evaluate the entire esophagus. It is not appropriate for postoperative retrosternal dysphagia because it does not evaluate the retrosternal anatomy. Fluoroscopy Pharynx Dynamic and Static Imaging Pharynx dynamic and static imaging is usually not appropriate because it is a double-contrast barium evaluation of the pharynx alone. A single-contrast esophagram with water-soluble contrast possibly followed with barium is more appropriate to evaluate for postoperative leak or fistula in a patient who has had surgery in the neck and is complaining of oropharyngeal dysphagia [42]. Furthermore, this study does not evaluate the thoracic esophagus and gastric cardia.
Dysphagia. Esophagrams have a slightly lower sensitivity and substantially higher specificity compared with CT for detecting leaks after esophagectomy [41]. Fluoroscopy Biphasic Esophagram Biphasic esophagram is not usually indicated when a patient has dysphagia in the immediate postoperative period. Single-contrast technique utilizing water-soluble contrast is preferable because evaluation for postoperative leak is the primary concern. Fluoroscopy Barium Swallow Modified When oropharyngeal dysphagia occurs postoperatively and there is a high index of suspicion for swallowing dysfunction, a modified barium swallow is the study of choice, especially if leak has been excluded clinically or with imaging. In the immediate postoperative period, if a leak or perforation is of clinical concern, a single-contrast esophagram with water-soluble contrast may be more appropriate because it is better suited to evaluate postoperative structural abnormalities. However, a modified swallow performed with water-soluble contrast material has been shown to be effective in the diagnosis of leakage [41]. In this study there were no adverse events associated with aspiration of iohexol as water-soluble contrast material [41]. A modified barium swallow examination does not evaluate the entire esophagus. It is not appropriate for postoperative retrosternal dysphagia because it does not evaluate the retrosternal anatomy. Fluoroscopy Pharynx Dynamic and Static Imaging Pharynx dynamic and static imaging is usually not appropriate because it is a double-contrast barium evaluation of the pharynx alone. A single-contrast esophagram with water-soluble contrast possibly followed with barium is more appropriate to evaluate for postoperative leak or fistula in a patient who has had surgery in the neck and is complaining of oropharyngeal dysphagia [42]. Furthermore, this study does not evaluate the thoracic esophagus and gastric cardia.