gastrograffin as an agent for contrast studies of esophageal injury

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In a message dated 8/22/2004 10:41:09 AM Eastern Standard Time,  
mmcbridemd at yahoo.com writes:


I  can honestly say that I've never seen a single death (nor significant  
morbidity) from gastrograffin aspiration. My brief literature search yielded 3  
case reports - all being patients with known dysphagia, and thus with  
contraindication for the use of gastrograffin in contrast swallow  studies.

I'm curious, under what circumstances are you witnessing these  aspiration 
events/deaths? Large series haven't uncovered aspiration risks with  properly 
administered water soluble contrast in trauma patients (see below).  
I have been using Barium for esophageal evaluation since 1979 after two  
patients died.  
One  sustained a penetrating injury of Zone I-II that resulted in an  acute 
tracheoesophageal fistula. The other patient with a Zone II  penetration 
aspirated and died without the presence of a significant  injury. 
 
In his article, Federle is speaking about water soluble contrast used to  
opacify the GI tract in preparation for CT. The contrast solution used in this  
case is quite dilute, a 3% solution of gastrograffin and water. The contrast  
necessary to evaluate the esophagus, stomach and duodenum by fluoroscopy and  
radiography must be of half or full strength opacity to adequately visualize  
these structures. 
 
sal

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