74221 Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study

Name of the Procedure:

Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (e.g., high-density barium and effervescent agent) study. Common name(s): Esophagram, Barium Swallow with Double-Contrast Imaging

Summary

An esophagram, or barium swallow, is a specialized X-ray test that allows doctors to examine the structure and function of the esophagus. This procedure uses a high-density barium solution and an effervescent agent to provide a detailed view of the esophagus.

Purpose

This procedure is used to diagnose swallowing disorders, esophageal tumors, strictures, and other esophageal problems. The goal is to provide clear images that help in identifying abnormalities in the esophagus.

Indications

• Difficulty swallowing (dysphagia)
• Chest pain not related to the heart
• Chronic heartburn or acid reflux
• Suspected esophageal tumors or strictures
• Unexplained weight loss
• Recurrent pneumonia

Preparation

• Fasting: Patients are generally instructed not to eat or drink anything for several hours before the procedure.
• Medication Adjustments: Patients may be advised to stop certain medications temporarily.
• Pre-procedure Assessment: A physical examination and review of medical history.

Procedure Description

1. The patient may undergo a scout chest radiograph as a preliminary step.
2. The patient drinks a high-density barium solution, which coats the esophagus.
3. An effervescent agent may be ingested to expand the esophagus by producing gas.
4. X-ray images are taken while the patient swallows the barium solution.
5. Delayed images may be captured to track the barium's movement through the esophagus over time.
6. The procedure may involve various positions to get comprehensive images.

No anesthesia or sedation is typically required.

Duration

The procedure usually takes about 30 to 60 minutes.

Setting

This procedure is typically performed in a hospital radiology department or an outpatient imaging center.

Personnel

• Radiologist: Interprets the X-ray images.
• Radiologic Technologist: Conducts the imaging process.
• Nurse or Medical Assistant: Provides patient care and assistance.

Risks and Complications

• Common: Mild discomfort or bloating from the effervescent agent.
• Rare: Allergic reaction to barium, aspiration of barium into the lungs, minor radiation exposure.

Benefits

• Provides detailed images of the esophagus.
• Helps diagnose functional and structural esophageal problems quickly.

• Non-invasive with minimal discomfort.

  Recovery

• Post-procedure: Patients can usually resume normal activities immediately.
• Hydration: Patients are often encouraged to drink plenty of fluids to flush out the barium.
• Bowel movements: Stools may appear white or light-colored for a few days.
• Follow-up: Any need for further appointments will depend on the results.

Alternatives

• Endoscopy: Offers direct visualization but is more invasive.
• Esophageal manometry: Measures motion and pressure but does not provide images.
• CT or MRI: Useful for detailed images but might not be as effective for certain diagnoses.

Patient Experience

During the procedure, the patient may feel a sense of fullness or mild bloating from the barium and effervescent agent. There should be minimal pain, and discomfort is generally very mild. Post-procedure, patients typically do not experience any significant pain and can quickly return to their regular activities.