Ann Rehabil Med.  2022 Oct;46(5):237-247. 10.5535/arm.22039.

Esophageal Motility Disorders in Patients With Esophageal Barium Residue After Videofluoroscopic Swallowing Study

• Park J
• Baek S
• Kim G
• Nam SJ
• Kim JH

• KMID: 2535741
• DOI: http://doi.org/10.5535/arm.22039

Abstract

Objective
To investigate esophageal motility disorders in patients with esophageal residual barium on chest x-rays after videofluoroscopic swallowing studies (VFSS) through high-resolution esophageal manometry (HREM).
Methods
We reviewed the records of 432 patients who underwent VFSS from September 2019 to May 2021, and 85 patients (19.7%) with large residual barium (diameter ≥1 cm) were included. As a result of HREM, motility disorders were classified as major or minor motility disorders according. Esophagogastroduodenoscopy and chest computed tomography results available were also reviewed.
Results
Among 85 patients with large residual barium in the esophagus, 16 patients (18.8%) underwent HREM. Abnormal esophageal motilities were identified in 68.8% patient: three patients (18.8%) had major motility disorders—achalasia (n=1), esophagogastric junction (EGJ) outflow obstruction (n=2)—and eight patients (50%) had minor motility disorders—ineffective esophageal motility (n=7), fragmented peristalsis (n=1). In those with normal esophageal motility, three patients of esophageal structure disorders (18.8%)—esophageal cancer (n=1), cardiogenic dysphagia (n=1), slight narrowing without obstruction of EGJ (n=1)—and two patients (12.5%) with chronic atrophic gastritis (n=2) were confirmed.
Conclusion
Esophageal motility disorders were identified in 68.8% of 16 patients with large esophageal residual barium with three patients in the major and eight patients in the minor categories. Residual barium in the esophagus was not rare and can be a sign of significant esophageal motility disorders.

Keyword

Deglutition disorders; Esophageal motility disorders; Endoscopy; Manometry

Figure

• 

  Fig. 1 Inclusion flow chart. VFSS, videofluoroscopic swallowing study; HREM, high-resolution esophageal manometry; EGJ, esophagogastric junction.

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  Fig. 2 Barium residues on chest X-rays taken after VFSS. (A) Barium content in the stomach with no residual esophageal barium (no barium group). (B) Small residual barium in the esophagus (<1 cm). End-level of esophageal barium was located 18.2 cm from T1 upper margin. (C) Large residual barium in the esophagus (barium ≥1 cm). End-level of esophageal barium was located 24.0 cm from T1 upper margin.

• 

  Fig. 3 Achalasia (case no#1). (A) Residual barium with a diameter of 2.5 cm was observed in the esophagus on chest X-ray. The end-level of the esophageal barium was located 23.0 cm from the T1 upper margin. Due to the fixed instrument, the bird beak sign is difficult to identify. (B) On esophageal manometry, impaired lower esophageal sphincter relaxation (integrated relaxation pressure >15 mmHg), absent peristalsis, and panesophageal pressurization were observed, which are reasonable findings for type II achalasia. (C) For the treatment of esophageal dysphagia due to achalasia, a balloon-catheter dilatation was performed at the esophagogastric junction.

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  Fig. 4 Esophagogastric junction (EGJ) outflow obstruction (case no#2). (A) Residual barium with a diameter of 1.8 cm was observed in the esophagus on chest X-ray. The end-level of esophageal barium was located 24.0 cm from the T1 upper margin. (B) On esophageal manometry, impaired lower esophageal sphincter relaxation (integrated relaxation pressure >15 mmHg) but peristalsis was observed, which are reasonable findings for EGJ outflow obstruction.

• 

  Fig. 5 Esophageal cancer (case no#12). (A) Residual barium with a diameter of 1.1 cm was observed in the esophagus on chest X-ray. The end-level of esophageal barium was located 13.0 cm from the T1 upper margin. A filling defect of the barium was observed for a length of 4.5 cm below the distal end of the barium, which was the middle thoracic esophageal level. (B) On esophagogastroduodenoscopy (EGD) and (C) chest computed tomography, a cancer narrowing the lumen was observed at the middle thoracic esophageal level, which corresponds to the chest X-ray. (D) To palliate esophageal obstruction caused by cancer, stent insertion was performed through EGD.

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