From the Guidelines
Barium swallow is not permitted after small bowel anastomosis, especially in the early postoperative period, due to the risk of barium spillage into the peritoneal cavity and subsequent complications. The use of barium contrast in suspected small-bowel obstruction is a topic of debate, with some studies finding it useful in managing suspected SBO in 68% to 100% of cases 1. However, in the context of recent small bowel anastomosis, the risks associated with barium contrast outweigh its potential benefits. Water-soluble contrast agents, such as Gastrografin, are preferred for the first 7-14 days following surgery because they are safer in case of extravasation.
Some key points to consider when evaluating the use of barium swallow after small bowel anastomosis include:
- The risk of barium spillage into the peritoneal cavity and subsequent inflammatory reactions, granuloma formation, and adhesions 1
- The limitations of small-bowel follow-through (SBFT) examinations with orally administered barium contrast, including nonuniform small-bowel filling and limitations posed by intermittent fluoroscopy 1
- The potential benefits of using water-soluble contrast agents in patients with post-operative SBO, although these benefits remain controversial and uncertain 1
In general, the decision to use barium swallow after small bowel anastomosis should be made on a case-by-case basis, taking into account the patient's recovery progress, absence of clinical signs of leak, and return of bowel function. If imaging is needed urgently in the early postoperative period to assess for a leak, CT scan with water-soluble contrast is typically the preferred diagnostic approach. After the initial healing period, typically 2 weeks post-surgery, barium studies may be considered if higher-quality imaging is needed, as determined by the surgeon.
From the Research
Barium Swallow After Small Bowel Anastomosis
- The provided studies do not directly address the question of whether barium swallow is permitted after small bowel anastomosis 2, 3, 4, 5, 6.
- However, the studies discuss the use of barium swallow in detecting anastomotic leaks after esophagectomy 2, 3, 5 and free jejunal transfer 4.
- The sensitivity and specificity of barium swallow in diagnosing anastomotic leaks vary across studies, with sensitivity ranging from 36% to 45% and specificity ranging from 93% to 97% 2, 3, 4.
- Some studies suggest that barium swallow can be used as an adjunct to clinical judgment in evaluating anastomotic competence, but it may not be reliable in predicting leaks 4, 5.
- There is no direct evidence to support or refute the use of barium swallow after small bowel anastomosis, and the decision to use this diagnostic tool may depend on individual clinical circumstances.
Key Findings
- Barium swallow has limited sensitivity in detecting anastomotic leaks after esophagectomy and free jejunal transfer 2, 3, 4.
- The test may be useful as an adjunct to clinical judgment, but it should not be relied upon as the sole means of evaluating anastomotic competence 4, 5.
- Further research is needed to determine the safety and efficacy of barium swallow after small bowel anastomosis.