A Modified Technique for Non-fluoroscopic Contrast Swallow in Younger Children Presenting in Resource Limited Setting
Adeniyi S. AderibigbeAbstract
Background:
Contrast swallow (CS) under fluoroscopic guidance remains an important investigation in exploring functional and structural oesophageal disorders. However, paucity of functional fluoroscopic machines in most secondary/tertiary hospitals and diagnostic centres in Nigeria makes the investigation less popular. Commendably, many radiologists currently improvise static X-ray machines to produce “non-fluoroscopic” CS spot images useful in investigating structural oesophageal pathologies. Unfortunately, both fluoroscopic and static CS are often limited in younger children by sub-optimal positioning with attendant risk of aspiration in the uncooperative minor.
Materials and Methods:
This manuscript presents a simple modified technique for diagnosing structural oesophageal lesions in younger children using the regular over-table X-ray machine angulated 30° cranially, while the child is positioned in 30° semi-recumbent position on a wedged imaging plate for additional comfort and stability. Flavoured contrast agent was then given in the same position and spot images were obtained. CS images/reports of younger children (≤6 years) conducted by a consultant radiologist over a 3-year period using the aforementioned technique were also reviewed.
Results:
The 22 retrieved cases of CS included children with median age of 2.0 years. The most common indications were postoperative assessment of surgical correction (45.5%) and dysphagia following corrosive substance ingestion (31.8%). Corrosive oesophageal stricture (29%) was the most prevalent oesophageal structural abnormality reported. All the studies produced clear spot images with conclusive diagnostic quality.
Conclusion:
Although not previously reported in published English literature, non-fluoroscopic CS in semi-recumbent position is helpful in assessing structural oesophageal abnormality when fluoroscopy is unavailable.