74220 Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study

Name of the Procedure:

Radiologic Examination, Esophagus, including Scout Chest Radiograph(s) and Delayed Image(s); Single-contrast (e.g., Barium) Study
Common name: Barium Swallow Test

Summary

A Barium Swallow Test is an X-ray imaging procedure that evaluates the structure and function of the esophagus, the tube that carries food from the mouth to the stomach. This test involves drinking a liquid containing barium, which helps to highlight the esophagus on X-ray images.

Purpose

The procedure is used to diagnose problems within the esophagus such as strictures (narrowing), blockages, hiatal hernias, and abnormalities in the muscular function of the esophagus. The primary goal is to identify structural or functional issues that might be causing symptoms like difficulty swallowing or chest pain.

Indications

• Difficulty swallowing (dysphagia)
• Chest pain not related to the heart
• Suspected hiatal hernia
• Gastroesophageal reflux disease (GERD)
• Chronic cough or hoarseness when other causes have been ruled out
• Unexplained weight loss

Preparation

• The patient may be instructed to fast for several hours before the procedure to ensure the stomach is empty.
• Any specific medications to avoid will be communicated by the healthcare provider.
• Pre-assessment might include a review of medical history and allergies.

Procedure Description

1. The patient stands or sits in front of an X-ray machine.
2. Initially, a scout chest radiograph may be taken.
3. The patient drinks a barium sulfate mixture, which coats the lining of the esophagus.
4. X-ray images are taken as the barium moves down the esophagus.
5. Additional delayed images may be captured to observe how the barium progresses through the esophagus.

No anesthesia or sedation is typically required.

Duration

The procedure usually takes around 30 to 60 minutes.

Setting

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

Personnel

• Radiologist: a physician specialized in interpreting medical images.
• Radiologic technologist: a technician who operates the imaging equipment and assists during the procedure.
• Possibly a nurse or medical assistant for patient care.

Risks and Complications

• Minor risk of aspiration (inhaling barium into the lungs)
• Constipation due to the barium
• Rare allergic reactions to the barium solution
• Potential discomfort or difficulty swallowing during the procedure

Benefits

• Provides detailed images of the esophagus for accurate diagnosis
• Non-invasive with minimal risk
• Immediate information about the structure and function of the esophagus

Recovery

• The patient can usually resume normal activities immediately after the procedure.
• Drinking plenty of fluids is recommended to help clear the barium from the system.
• Some patients may experience light-colored stools for a day or two following the exam.

Alternatives

• Endoscopy: a more invasive procedure using a flexible tube with a camera to visualize the esophagus.
• Esophageal manometry: measures the rhythmic muscle contractions of the esophagus.
• CT scans or MRI: other imaging techniques might be used based on specific diagnostic needs.

Patient Experience

During the procedure, the patient may taste the chalky texture of the barium solution, which can be slightly unpleasant. There is usually no pain involved, though some discomfort may occur. Post-procedure, patients might feel constipated, and guidelines will be provided to mitigate this. Pain management is generally not necessary.