Implementation of a Timed Barium Esophagram Protocol for Assessment of Esophageal Function in Children.

OBJECTIVES Timed Barium Esophagram (TBE) is a fluoroscopic study that is widely-employed as an adjunctive tool for diagnosing esophageal emptying disorders in adults (eg. achalasia, esophagogastric junction outflow obstruction [EGJOO]) and for following response to treatment. We aimed to describe the characteristics and feasibility of a pediatric TBE protocol and provide a first report of the potential value of TBE for assessment of esophageal emptying in the pediatric population. METHODS Retrospective chart review of pediatric patients at a tertiary pediatric hospital who underwent TBE from October 2017-October 2019. Patient and test characteristics were summarized using descriptive statistics. Results from patients who had both TBE and high resolution esophageal manometry (HRM) were used to generate ROC curves for TBE to identify esophageal emptying disorders. RESULTS Twenty-two patients underwent 25 TBE. 14/23 (61%) received 150 mL barium volume per protocol. Nearly half (42%) of subjects could tolerate ingesting barium within 20 seconds. Nine individuals underwent HRM. The sensitivity of standard adult TBE criteria (1 cm barium column height at 5 min) to detect emptying disorder was 100%, specificity 40%. A modified diagnostic cutoff (1.6 cm height at 5 min) offered 100% sensitivity, 80% specificity. CONCLUSIONS TBE is feasible and should be considered an adjunctive noninvasive screen for impaired esophageal emptying in children. There was heterogeneous adherence to protocol for timing and volume of barium; however, studies remained interpretable. This population may benefit from different diagnostic cutoffs than adults, and clinical judgment should be used until specific diagnostic cutoffs are determined in children.