title: Follow-up barium study after a negative water-soluble contrast examination for suspected esophageal leak: is it necessary?
abstract: The purpose of this study was to determine the value of follow-up barium esophogram in diagnosing esophageal injury or leak if the initial water-soluble contrast examination of the esophagus is normal. An institutional review board (IRB)-approved retrospective review of all pediatric patients less than 18 years old referred to the radiology department for evaluation of esophageal injury or leak was performed for a 9-year period from 2005 to 2014. The majority of patients had unexplained pneumomediastinum, chest trauma (gunshot or puncture wound), or foreign body ingestion as the reason for the referral. Forty-nine patients (age range 10 days to 17 years) underwent an initial water-soluble esophogram immediately followed by a barium esophogram. Forty-six studies were negative on both water-soluble contrast and barium studies. Two studies were both positive on the initial water-soluble contrast and subsequent barium studies. A single study showed the esophageal leak only in the water-soluble study, with the follow-up barium exam being normal. The result of this study indicates that a single-contrast water-soluble esophogram alone is sensitive in the diagnosis of esophageal injury or leak. It has a 100 % sensitivity and negative predictive value. A follow-up barium esophogram only increases the study time and radiation dose to the patient.
authors.affiliation: Division of Pediatric Radiology, University of California, Davis Medical Center and UC Davis Children's Hospital, 4860 Y St. Suite 3100 ACC, Sacramento, CA, 95817, USA. trsanchez@ucdavis.edu.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Sanchez
authors.affiliation: Department of Radiology, University of California, Davis, Medical Center, Sacramento, CA, USA.
authors.forename: Grant S
authors.initials: GS
authors.lastname: Holz
authors.affiliation: Department of Radiology, University of California, Davis, Medical Center, Sacramento, CA, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Corwin
authors.affiliation: University of California, San Diego, CA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wood
authors.affiliation: Division of Pediatric Radiology, University of California, Davis Medical Center and UC Davis Children's Hospital, 4860 Y St. Suite 3100 ACC, Sacramento, CA, 95817, USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
mesh_terms: D000293:Adolescent; D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004939:Esophageal Perforation / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000293:injuries*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011859:Radiography; D012189:Retrospective Studies; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D001466:Barium Sulfate; C044834:iodixanol
keywords: Barium; Esophageal injury; Esophageal leak; Esophogram; Water-soluble contrast