Barium sulfate: a new (old) contrast agent for diagnosis of postoperative esophageal leaks.
OBJECTIVE
To determine whether esophagography with use of barium alone is safe for detection of postoperative leaks of the esophagus.


METHODS
A review was performed of 29 postoperative esophagograms that showed 29 leaks in 12 patients. All studies were performed with a 50% dilution of barium sulfate. Leak volumes were calculated as the product (in cubic centimeters) of the length, width, and height. The safety and efficacy of barium were determined on the basis of development of mediastinitis and retention of barium in the mediastinum that would interfere with subsequent patient care.


RESULTS
In 11 of the 12 patients, follow-up studies were performed 4-48 days (mean, 10.2 days) after diagnosis. Leaks were 0.25-375 cm3 (mean, 31.4 cm3). In five of 17 (29%) follow-up procedures, small amounts of residual barium were detectable on the scout radiograph, none of which interfered with interpretation of the new images. During a follow-up period of 7-448 days (mean, 226 days), no cases of mediastinitis were found.


CONCLUSIONS
Esophagography can be performed safely with barium to rule out an anastomotic esophageal leak.
Gollub
M J
MJ
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Bains
M S
MS
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001466:Barium Sulfate; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies
D001466:Barium Sulfate