From the Guidelines
The false negative rate for barium esophagram in finding a leak is approximately 64%, as the sensitivity of the esophagram in diagnosing a leak was found to be 36%. This means that barium studies miss about two-thirds of actual leaks, making them less reliable than other imaging modalities for this specific purpose 1. The use of water-soluble contrast followed by barium if necessary is recommended when there is a question of leak or fistula. Key points to consider include:
- The sensitivity of esophagography increased when high-density barium was administered after water-soluble contrast 1.
- Esophagrams have a slightly lower sensitivity and substantially higher specificity compared with CT for detecting clinically relevant leaks after esophagectomy 1.
- The use of CT as the initial imaging test in these patients can lead to earlier diagnosis and treatment of leaks missed on esophagography 1. For patients with suspected esophageal perforation, a negative barium study should not completely exclude the diagnosis if clinical suspicion remains high, and additional imaging or endoscopic evaluation should be considered. CT scans with water-soluble contrast have better sensitivity, with false negative rates potentially lower than that of barium studies 1.
From the Research
False Negative Rate for Barium Esophagram in Finding a Leak
- The false negative rate for barium esophagram in finding a leak is a significant concern, as it can lead to delayed diagnosis and treatment of anastomotic leaks after esophagectomy 2.
- A study published in 1988 found that Gastrografin swallow had a high false-negative detection rate, which might be related to the inferior radiographic detail provided by this contrast medium 3.
- Another study published in 2017 found that routine contrast esophagram had a low sensitivity in detecting cervical anastomotic leaks, with a false-negative rate of 47.8% 2.
- In contrast, a study published in 2015 found that a single-contrast water-soluble esophogram alone was sensitive in the diagnosis of esophageal injury or leak, with a 100% sensitivity and negative predictive value 4.
- The use of barium esophagogram in detecting anastomotic leaks is still a topic of debate, with some studies suggesting that it is not advised for patients with cervical anastomoses due to its low sensitivity 2.
- However, barium esophagogram remains a valuable test for structural and functional evaluation of the esophagus, and can be used to detect various esophageal diseases 5, 6.