ESOPHAGOGRAPHY Double Contrast (+ and – CM)

- Barium and carbon dioxide

- Low viscosity – high density barium

Indications

- Evaluation of masses
- Strictures (narrowness)
- Odynophagia (painful swallowing)
- Foreign Body
gullet or esophagus - Gastroesophageal Reflux Diseases (acid
reflux) (GERD)
begins c6, ends in t11
- Globus or Lump in the throat
Four (4) Normal Points of Narrowness in the
Esophagus: - Swallowing difficulties

Contraindications
1. Cricoid Cartilage
2. Level of the Aortic Knob - Patient who have undergone:
3. Opposite of the Crossing of the Left • Recent esophageal or gastric surgery
Bronchus
• Recent trauma are not candidates for
4. Esophageal Hiatus of the Diaphragm double contrast examination

deglutition or swallowing aspect of esophagus (oral to

**AP or PA – whole aspects of esophagus;
esophagus)
magkakaron ng superimposition sa spine
**Lateral – flex at 90o; taas yung kamay to avoid
superimposition (although macocover parin ng
shoulder); swimmers swing alternative

**PA Oblique Projection (RAO) – best view; LAO is

the alternative

hypaque swallow– water soluble (gagamitin lang pag may

perforation)

Modifications:

Cardiac Esophagogram – demonstrates relationship

between heart & esophagus

**superimposition sa lungs

Gunson Method – dark-colored shoestring (metal tips

removed) is tied around the patient’s throat above
Full Column, Single Contrast the thyroid cartilage (adam’s apple)

Modified Esophagogram – essentially the same procedure as

- 30-50% weight/volume Barium Suspension the typical esophagogram but patient is made to swallow
- Used to fill the esophageal lumen
tufts or pledgets of cotton with contrast medium or Recumbent is preferred because of more complete
marshmallow injected with contrast medium. filling of the esophagus (caused by the gravity factor
with erect position)
**gagawing string yung cotton tas papainumin (tas sasabit
yung cotton dun sa radiolucent), used sa radiolucent lang Exposure times or 0.01 sec. or 0.1 sec or less
should be used to avoid motion

**Fluoro – susundan ng XRT yung paglunok nung patient

**Varices (enlargement of vessels) are involuntary

Techniques for GERD

1. Water Test

S1: have the px in recumbent (LPO) (supine)

S2: Stomach will be filled w/ barium sulfate

S3: Iinom water (LPO)

- Hahalo sa barium
- Continuous siphoning (Transfer) of water
- Esophagus must be black

**If yung esophagus puti, bumabalik yung barium

meaning may GERD

Problem: Pathologies

• Kapag nakahiga, mahirap uminom due Achalasia

to gravity
• Aspiration of Water • Happens if the muscles during
ingestion fails to relax

2. Compression Technique • Can happen in any part of a muscle

S1: Using compression band, lagyan ng

pressure sa abdomen/stomach para makita
if babalik sa esophagus.

**Contraindication: abdominal pain

Problem: pain

3. Toe-touch Maneuver

S1: Before swallowing, touching the toe na nakatayo.

**Dapat di bababa yung barium

For esophageal achalasia: pwede lumaki yung
esophagus showing a bird beak-like/sigmoid
Problem: kung kaya nung patient
appearance; narrow yung baba ng esophagus

4. Valsava Manuever

S1: parang I-IRI by blocking the nose and mouth.

Problem: Amount of pressure, Depende sa force

nung patient
Barrett Esophagus Drug-Induced Esophagitis - Umiinom ng malalaking
tablets/drugs
• Peptic ulcer on the lower esophagus
• Inflammed, magkakaron ng ulceritis
• Nagkakaron ng fossa/butas-butas sa
lumen
• Nasusunog/natutunaw yung
esophagus

Esophageal Carcinoma

Napkin-ring/apple core appearance

• Esophagitis
• Candida Esophagitis o Inflammation
due to candida (yeast)
• Form of yeast infection
• Throat, mouth, esophagus
(Common)
infection to people who have HIV, AIDS (its not Esophageal Foreign Body - may tirang meat pa sa
putting-puti sa film) lalamunan hindi nanguya Mabuti

Caustic Esophagitis -Due to corrosive substances Esophageal Motility Disturbances (Corkscrew

appearance)
• The cause is usually suicidal
attempts
• (Drinking bleach and such), • aka Diffuse Esophageal Spasm (DES) o
Uncoordinated peristaltic contraction
people who have a mental
& relaxation
disorder
 • Stomach will be above the diaphragm
Schatzki Ring
• Ring like narrowing
zenker diverticulum - outpatching
Stomach
- Dilated, sac like portion of the digestive
tract extending between the esophagus
and the small intestine
- It takes 1-4 hours for gastric emptying
- 6 hour is considered the maximum
normal emptying time of the stomach
Four Parts of the Stomach
1. Cardia of the Stomach
• Is the section
• Immediately surrounding the
esophageal opening
2. Fundus
• Superior portion of the stomach that
expands superiorly and fills the
dome of the left diaphragm
3. Body
• Descending from the fundus and
beginning at the level of the cardiac
notch and ends at the plane passing
through the angular notch and
sulcus intermedius
4. Pyloric Portion
• Distal portion of the stomach
Indications
- Strictures
- Obstruction
- Tumors/Masses
- Hiatal Hernia
- Varices
- Fistulas
- Gastroesophageal Reflux
- Unexplained Weight Loss
- Ulcerations
- Polyps
Contraindications
- If perforation (holes in stomach) is
suspected, water-soluble contrast is used
by convention
Preliminary Preparation
1. Question the patient about:
• Relevant symptoms
• Previous abdominal surgery
• Having been NPO since midnight
• The possibility of pregnancy
2. Explain the procedure to the patient
• Describe how to perform breath-
holding during spot filming (ex.
“Don’t take in a breath; just stop
breathing”).
Caution the patient not to belch (dumighay) after
drinking the “bubbly barium”.
Single Contrast
• also known as single-contrast
graded-compression (SCGC)
technique
 • uses a medium-density barium Patient Preparation
suspension that permits a
combination of meaningful 1. Colon free of gas and fecal material. Non-
compression filming gas forming laxative may be given 1 day
1. Barium Suspension (30% – 50% before.
weight/volume) 2. Soft, low residue diet for 2 days
3. Cleansing enemas may be given
2. Place the patient in upright position
4. NPO (nothing by mouth) for 8-9 hours
3. Manual manipulation of the patient’s 5. No smoking and/or chewing gum after
body midnight

4. If there’s esophageal involvement (thick

Barium suspension)

**Positive CM

Double Contrast
A relatively small quantity of high-
density is used to demonstrate fine
mucosal detail, and distension.
Double contrast is achieved by
means of a gas-producing agent.
F- fundus
1. Place the patient in upright position. P – pyloric
2. Give gas-producing substance
3. Give the High-density barium suspension
(weight/volume ratio up to 250%)
4. Place the patient in recumbent position Ba Air
and turn from side to side
AP F P
**Positive & Negative CM
LPO F P
Biphasic
• Both single- and double- PA P F
contrast incorporated together
• The goal of biphasic RAO P F
examination is to have both mucosal and
delineation in the doublecontrast phase
and full column distension in the single-
contrast phase. The advantage of this
method is that it images some lesions
better than by double contrast alone
**single muna bago double
**2 phase (for PA Proj) PA Axial
- CR: 35-45o cephalic (Gordon’s Method)
• Used on hypersthenic patient
• Separates overlapping of pyloric
region of stomach & duodenal bulb -
CR: 20-
• 25o cephalic (Gugliantini method)
• For infants to recom. to open the
body & pylorus of stomach

(for AP Proj) AP Trendelenburg

- Partial Trendelenburg
• Necessary to fill the fundus on a
thin asthenic patient - Full
Trendelenburg Angulation
• CR: 25-30o
• Facilitates demonstration of
histal hernia
 PA Axial Projection: Gugliantini Method (bata)
- 20-25o cephalad
- For infants

PA Axial Projection: Gordon Method(matataba)

- Prone, IR centered 4” to the left of the
pylorus 35-45o cephalad

Poppel’s Method
- Lateral – biplane (2 Fluoroscopic real
time imaging) projections in supine
position

- Detects any space-occupying lesion of the

pancreas, retrogastric space **for hosp.
that has 2 fluoro

Hampton’s Modification

- Supine, body obliqued 45o so that bulb is

separated from the vertebrae
- Best modification to demonstrate a “leaf-
like pattern” of the pylorus & the bulb

**R. Lat. – pinapakita yung harap at likod nung

stomach

Demonstration of Hiatal Hernia

1. Trendelenburg Position
2. Wolf Method (PAO Projection, RAO
Position)
• No angulation of the table but
utilizes a semi-cylindrical radioparent
compression device (l = 22”, w = 10”,
h = 8”)
• Demonstrates relationship of
stomach to diaphragm, useful for
demonstrating hiatal hernia
• 40-45o RAO position, CR: 10-20o
caudad to T6-T7, patient in modified
knee-c

**semi-cylindrical sa tiyan
Hypotonic Duodenography
3. Sommer-Foegelle Method
- gives special emphasis to the c-
loop/duodenum - Utilizes a specially constructed 34o angle
- diagnostic tool for evaluation of post- board in which the patient is flexed to
bulbar duodenal lesions & detection of place his trunk in a trendelenburg
pancreatic disease, requires duondenal position. Exposure made during Mueller
intubation & temporary drug-induced Maneuver.
paralysis so that a double-contrast
examination can be performed.
**shows pancreas
**lesion sa duodenum and pancreas yung nakikita
Gastric Volvulus
Twisting of an organ
Zollinger-Ellison Syndrome
Ulceritis lang din siya