Introduction Whereas gastroenterology and upper GI surgery have largely abandoned barium swallow for diagnostic purposes, ENT surgeons still request barium swallows to investigate patients with “high dysphagia”. We analysed these from a cost effective point of view.
Method All Barium Swallows requested by ENT surgeons as the primary investigation of “dysphagia” over a two year period were retrospectively reviewed. Requests were filtered to only include ENT requests with dysphagia as the clinical indication. Whether these patients went on to OGD was also determined.
Results 246 Barium Swallows were completed between January 2013 to December 2014. 51% (126) were reported as normal, and the most common diagnoses were gastro-oesophageal reflux (44), hiatus hernia (45) and oesophageal dysmotility (31). Pharyngeal pouch was diagnosed in nine patients. No patients had hypopharyngeal tumours.
Suspicion of oesophago-gastric malignancy was reported in 16 patients with four patients subsequently confirmed to have oesophageal cancer on OGD. The average wait in these patients from request of Barium Swallow to histological diagnosis was 37 days, breaching the 31 day target.
72 Patients (26%) went on to have an OGD, and this provided additional diagnostic information in 56% (40) including Barrett’s Oesophagus in 4%. If all patients had been initially investigated with OGD, instead of Barium Swallow, a net saving of £1,400 would have been made.
Conclusion Diagnostic barium swallow for dysphagia delays diagnosis of oesophageal cancer and overall is more expensive than the preferred definitive OGD.
Disclosure of interest None Declared.
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