Esophageal perforation: Comparison of use of aqueous and barium-containing contrast media

PURPOSE: To assess the need for follow-up esophagography with barium-containing contrast medium after examination with a water-soluble contrast medium in the detection of esophageal perforation. MATERIALS AND METHODS: Sisty-seven patients suspected of having esophageal perforation were examined prospectively with use of an aqueous contrast medium during a 1-year period. The examinations were performed with a digital fluoroscopy unit Eighteen patients without proved extravasation at esophagography performed with aqueous contrast medium and without other contraindications underwent esophagography with barium-containing contrast medium. RESULTS: In four of 18 patients (22%) with unremarkable findings at esophagography performed with a water-soluble contrast medium, a perforation was detected subsequently with use of a barium-containing contrast medium. No complications related to barium extravasation occurred. CONCLUSION: Patients suspected of having esophageal perforation and who have unremarkable findings at esophagography with water-soluble contrast media need to undergo follow-up esophagography with a barium-containing contrast medium. The use of a digital fluoroscopy unit does not obviate the follow-up examination.