E1807. Dynamic Imaging of Thoracic Esophagus
  1. Ameen Kamona; University of Toronto
  2. Nasir Jaffer; University of Toronto
  3. Dilkash Kajal; University of Toronto
  4. Lawrence Stein; McGill University
Barium imaging of the esophagus is a safe and cost-effective modality for the evaluation of esophageal symptoms including dysphagia as well as for assessment of the esophageal function and motility. Given the worldwide effort to limit the spread of the coronavirus disease 2019 (COVID 19) with more reliance on virtual clinics, there has been a significant decrease in gastrointestinal endoscopies, manometry and, 24-hour pH monitoring with resultant backlog of these procedures. This provides a great opportunity to more effectively utilize dynamic imaging of the esophagus as a screening tool for most esophageal symptoms, especially for motility disorders which are more prevalent in the geriatric population. Therefore utilizing this screening tool, would effectively lower the number of backlogged endoscopic procedures without compromising the safety of the patients.

Educational Goals / Teaching Points
Highlight the value and techniques of barium studies as a screening and diagnostic tool for esophageal motility disorders, discuss the Chicago Classification clinical terminology used to describe esophageal motility disorders on barium studies, and review the spectrum of esophageal motility disorders that can be diagnosed using dynamic imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Type of study imaging technique: esophageal motility NYD (thoracic esophagus, stomach & duodenum; prone drinking; marshmallow study), achalasia (thoracic esophagus, stomach & duodenum, prone drinking; marshmallow study), specialized imaging studies (timed barium study for post OP achalasia, a 1 min and 5 min upright thoracic esophagus; include stomach & duodenum, prone drinking). Physiology of esophageal peristalsis: primary peristalsis (with barium swallow, upper esophageal sphincter relaxes, peristaltic wave begins immediately producing a contraction of esophageal circular muscle, the peristaltic wave migrates downwards). Secondary peristalsis refers to peristalsis activated by esophageal distention. This occurs physiologically (by food left behind after primary peristaltic wave has passed or by refluxed contents from the stomach). Dsymotility: abnormal movements (refer to Chicago Classification 4.0 for newer terminology). Some examples (tertiary contractions [uncoordinated peristalsis]), diffuse esophageal spasm [DES], achalasia [high lower esophageal sphincter tone]). Using the Chicago classification for esophageal motility on barium study reports enables effective referral to GI specialist for early treatment. Chicago classification of esophageal motility disorders (disorders of esophago-gastric junction outflow, esophagogastric junction outflow obstruction [EGJOO], disorders of peristalsis.

Understanding the value of dynamic imaging of the esophagus, and having knowledge of esophageal motility disorders will prevent delays in diagnosis and treatment, and reduce the backlog of postponed endoscopy procedures.