David Geffen School of Medicine at UCLA Los Angeles, CA
Jeremy Wang, MD1, David Lin, MD2, Andrew Erman, MA3, Dinesh Chhetri, MD3, Jeffrey Conklin, MD3; 1David Geffen School of Medicine at UCLA, Los Angeles, CA; 2Santa Clara Valley Medical Center, San Jose, CA; 3Ronald Reagan UCLA Medical Center, Los Angeles, CA
Introduction: The modified barium swallow study (MBSS) is performed to evaluate oropharyngeal dysphagia. The scope of the MBSS does not typically include a screen for esophageal function. At our institution, a brief fluoroscopic assessment for retained esophageal contrast is performed in addition to the standard exam. A positive finding may indicate an underlying esophageal motility disorder requiring high-resolution esophageal manometry (HREM) evaluation. Retained esophageal contrast on MBSS may serve as a screening tool for esophageal dysmotility. Methods: We performed a retrospective analysis of all patients ≥18 years of age who underwent both MBSS and HREM at our institution between January 2014 and September 2019.Patients undergoing MBSS have a fluoroscopic image of their esophagus taken 1 minute after the last radiographically evaluated swallow. Retained contrast causingesophageal distension is considered a positive finding. Patients who were evaluated for dysphagia and had retained esophageal contrastwere included in our analysis.We analyzed their HREM and classified abnormalities according to the Chicago Classification v3.0 (CC). Results: A total of 547 patients underwent both MBSS and HREM at our institution between theaforementioneddates. To date, we have analyzed 123 patients, 46 of which had dysphagia and retained esophageal contrast.Upper endoscopy was performed in 41 (89.1%) patients, none of which noted an anatomic obstruction. On HREM, 36 (78.3%)patients had abnormal findings, 31 (67.4%) of which were classifiable according to the CC. Under the CC, 2 (4.3%) had achalasia, 13 (28.3%) had esophagogastric junction outlet obstruction, 1 (2.2%) had diffuse esophageal spasm, 3 (6.5%) had jackhammer esophagus, 3 (6.5%) had absent contractility, 9 (19.6%) had ineffective esophageal motility, and 1 (2.2%) had fragmentedperistalsis. Non-classifiable abnormalities included hypertensive lower esophageal sphincter, weak striated muscle peristalsis, and elevated supine integrated relaxation pressure that normalized when upright. Discussion: The majority of patients with dysphagia and retained esophageal contrast on MBSS had abnormal HREM in our preliminary analysis. A screen for retained esophageal contrast should be addedto the MBSS as it likely indicates an underlying treatable esophageal motility disorder.
Sample image of retained esophageal contrast on modified barium swallow study 1 minute after the last radiographically evaluated swallow.
High-resolution esophageal manometry findings in patients with dysphagia and retained esophageal contrast on modified barium swallow study
Abnormalities on high-resolution esophageal manometry classified according to the Chicago Classification v3.0. EGJOO, esophagogastric junction outlet obstruction; DES, diffuse esophageal spasm
Disclosures: Jeremy Wang indicated no relevant financial relationships. David Lin indicated no relevant financial relationships. Andrew Erman indicated no relevant financial relationships. Dinesh Chhetri indicated no relevant financial relationships. Jeffrey Conklin indicated no relevant financial relationships.