The Use of Low-Osmolar Water-Soluble Contrast in Videofluoroscopic Swallowing Exams

Abstract

The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. The contrast agent used was selected by the speech language pathologist (SLP) or the radiologist based on the exam's indications. A total of 1,978 fluoroscopic exams were completed in the 12-month period of documentation. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.

The effect of aspirated barium sulfate, iodixanol, and diatrizoic acid on survival and lung injury in a lagomorph model

“…19 Because of the potential side effects caused by barium aspiration and its persistence, radiographers have utilized water-soluble contrast agents. 20 Water soluble agents have the advantage of being more rapidly absorbed, reducing the risk of chronic infection and granuloma formation. The radiopacity of most commercially available water-soluble agents, however, is reduced compared to barium.…”

Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models

“…An alternative to barium is iohexol, an iodine-based contrast agent that has only recently been recognized as a suitable alternative to barium sulfate for human VFSS 10 ; thus, it has not yet been standardized for this purpose. Several different concentrations of chocolate-flavored iohexol were offered to mice.…”

Fluoroscopic Evaluation of Oropharyngeal Dysphagia: Anatomic, Technical, and Common Etiologic Factors

“…Oral agents used for fluoroscopic evaluation of swallowing include either barium or non-ionic water soluble contrast [28, 29]}. Barium may be prepared in different concentrations, and/or mixed with thickening agents to simulate different liquid and food consistencies [15].…”

“…For patients who have undergone surgery involving the neck or the esophagus, water soluble contrast is used initially to assess for anastomotic leaks. Due to the reported risk of chemical pneumonitis, high osmolar iodine based agents are not recommended for use in patients who may aspirate [28]. …”