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Mon Sep 3 05:11:08 BST 2007

For me there is no debate.    The preference for water  soluble is an urban 
legend, and based on ONE paper I can find in the Radiology  literature relating 
to problems in the ABDOMEN when barium is left in the  abdomen after 
perforation of the colon during Barium  enema.     There is virtually no DIRECT data 
for the  esophagus, so one must use indirect information.   

Barium was used for decades for contrast bronchograms when bronchectasis  was 
common.   The lungs tolerated barium very well.     When gastrografin is 
used, or any of the water soluble solutions, and there is  aspiration occurs, 
chemical pneumonia can be fierce.    So score  ONE for BARIUM.  

Gastrografin has a habit of giving false positive results on  esophagograms.  
 Barium has a much lower incidence of false negative  results.    SCORE one 
for BARIUM

If one must put a risk of pneumonitis on the patient and use gastrografin,  
one should accept the result ONLY if it is POSITIVE.    Since one  is doing an 
esophagogram because they suspect an esophageal injury, if the  results are 
negative with gastrografin, then it should be immediately repeated  with Barium. 
  Score one more for barium.  

This is THREE votes FOR barium to be used the first time 

If there is an injury and it is documented, then go to the OR and fix the  
injury and clean out the barium.   DOI NOT make a simple situation any  more 
difficult .    

k

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Barium vs Gastrografin for esophagogoscopy