Special Procedure: Dynamic Esophagography
Radiographic study is done using positive contrast media (barium or non-ionic iodine) of different types and textures to evaluate esophageal location and morphology. Fluoroscopy is the optimum technique for the assessment of esophageal motility and function, particularly in oropharyngeal disorders.
Indications for this procedure :
- Assessing an animal with suspected esophageal or pharyngeal disease based on clinical signs of regurgitation, gagging or dysphagia.
- Evaluating an animal with a foreign body, stricture (including vascular ring anomalies) or trauma to the esophagus.
- Evaluating the esophagus for abnormal position in an animal with a cervical or mediastinal mass.
- Assessment of esophageal motility.
Contraindications and complications for this procedure :
- Benefits of the procedure need to be weighed against risk of aspiration - however, the contrast media themselves (including barium) are not toxic or otherwise harmful to the airways. Complications result from aspirating a large volume of material (rare in this setting) and/or contamination of the aspired material with bacteria from the GI tract.
- Easily defined, moderate to severe, uniform gas dilation of the esophagus on survey radiographs without clinical evidence of oropharyngeal dysphagia is a RELATIVE contraindication to the procedure. Esophagography generally does not contribute any further information in such cases. Cases that are suspected of having oropharyngeal disease AND generalized megesophagus should be assessed, however.
- Barium leakage through a tear in the esophagus or pharynx can result in a granulomatous cellulitis/mediastinitis. Non-ionic iodine is used as an initial medium in cases where a tear is suspected, but may not show all tears, so negative iodine studies are followed by barium studies.
- Ideally, an upper GI (UGI) series should not immediately follow an esophagogram as barium-coated food is given as part of this study, which can interfere with interpretation of an UGI. If it is known that both procedures will be done, the esophagogram should follow the UGI wherever possible.