Double-contrast Barium Studies Research Articles

Killian-Jamieson diverticulum

A 52-year-old gentleman presented with suprasternal dysphagia and cough for 3 months. Double-contrast barium study (Fig. 1) revealed a small left-sided Killian-Jamieson diverticulum. These diverticula originate on the anterolateral wall of the proximal cervical esophagus in a gap inferior to the cricopharyngeus and lateral to the longitudinal muscle of the esophagus [1]. Differentiation from Zenker’s diverticulum is based primarily on the radiographic findings. The opening of a Zenker’s diverticulum is above the level of the cricopharyngeus, with the sac lying posterior to the cervical esophagus on lateral images and in the midline on frontal images. On the other hand, the opening of a KillianJamieson diverticulum is located just below the level of the cricopharyngeus with the sac lying lateral to the cervical esophagus on frontal images and overlapping the anterior wall of the cervical esophagus on lateral images [2]. An accurate anatomic delineation helps in surgical planning.

Computed tomographic air-contrast enema imaging for presurgical examination of colon tumors: assessment with colon phantoms and in patients

We investigated the mechanism of colon wall deformities in phantoms and assessed the relation between pathological T staging and wall deformity in patients using computed tomography (CT) enema imaging. We performed multidetector-row CT in mass-containing phantoms with no structural deformities and in 36 patients with colon tumors. In the phantoms, we compared images on double-contrast barium (DCB) and CT enema studies, and we compared wall deformities on CT enema studies and the actual phantom structure. In patients, we compared wall deformities on CT enema studies and T staging. Images from CT enema and DCB studies were identical in the phantom, and all profile images showed geometrical basal indentations. In patients, the grade of deformity increased with invasion depth; and the diagnostic accuracy of T staging was 82.5%. Geometrical basal indentation and poor colon expansion were the primary reasons for overestimating T staging on CT enema imaging. Although CT enema imaging allows reasonable diagnostic accuracy of T staging, wall deformity is thought to be consistent with tumor infiltration and other factors. We recommend evaluating T staging using not only CT enema imaging but also other techniques, such as virtual endoscopy, axial imaging, and multiplanar reformation imaging.

Pyogenic granuloma of the descending colon

A 59-year-old woman who was known to have large hepatic cysts presented with a positive fecal occult blood test. Her physical examination was unremarkable, and laboratory testing revealed no abnormalities. A double-contrast barium study showed a round, radiolucent area in the descending colon. Colonoscopy revealed a light-red, sessile lesion, about 15 mm in diameter, which consisted of variously-sized nodules covered with white exudate ([Fig. 1]). The rest of the colonic mucosa was unremarkable. When the specimen was biopsied massive bleeding occurred, suggesting that the lesion was hypervascular. Histological examination of the biopsy specimen showed proliferation of capillaries.

Inflammatory chronic disease of the colon: How to image

Inflammatory bowel disease, including Crohn's disease and UC, is a chronic disorder of the gastrointestinal tract. The inflammatory process in UC is confined to the mucosa and submucosa and it involves only the colon. In contrast, in Crohn's disease the inflammation process extends through the bowel wall layers and it can involve any part of gastrointestinal tract. Moreover, inflammatory bowel disease of the colon may be associated with complications, such as toxic megacolon, fulminant colitis, acute bleeding, fistulas and abscesses. Radiographic imaging studies are useful for the diagnosis of inflammatory bowel disease, and may be used to assess the extent and severity of disease, rule out complications, and monitor the response to therapy. The double-contrast barium study is a valuable technique for diagnosing inflammatory bowel disease colonic alterations, even in patients with early mucosal abnormalities. The earliest finding of UC is characterized by a fine granular appeareance of the colonic mucosa, usually involving the rectosigmoid junction. In chronic UC double-contrast enema may reveal marked colonic shortening with tubular narrowing of the bowel and loss of haustration. The earliest radiographics findings of Crohn's disease are represented by aphthous ulcers. As disease progresses, aphthous ulcers may enlarge and coalesce to form stellate or linear areas of ulceration. In advanced Crohn's disease, transmural ulceration may lead to the development of fissures, sinus tracts, fistulas, and abscesses. Cross sectional studies such as computed tomography, magnetic resonance imaging and sometimes ultrasound, are useful alternative tools not only in the assessment of bowel wall abnormalities, but also for the assessment of extraluminal alterations in patients with advanced disease.

Invited Commentary

HomeRadioGraphicsVol. 26, No. 4 PreviousNext RSNA Education ExhibitsInvited CommentarySanjeev Bhalla1Sanjeev Bhalla1Author Affiliations1Mallinckrodt Institute of Radiology, St Louis, MissouriSanjeev Bhalla1Published Online:Jul 1 2006https://doi.org/10.1148/radiographics.26.4.0261117MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 ArchieV, Kauh J, Jones DV Jr, Cruz V, Karpeh MS Jr, Thomas CR Jr. Gastric cancer: standards for the 21st century. Crit Rev Oncol Hematol2006;57:123–131. Crossref, Medline, Google Scholar2 WaneboHJ, Kennedy BJ, Chmiel J, Steele G Jr, Winchester D, Osteen R. Cancer of the stomach: a patient care study by the American College of Surgeons. Ann Surg1993;218:583–592. Crossref, Medline, Google Scholar3 LowVH, Levine MS, Rubesin SE, Laufer I, Herlinger H. Diagnosis of gastric carcinoma: sensitivity of double-contrast barium studies. AJR Am J Roentgenol1994;162:329–334. Crossref, Medline, Google Scholar4 LimJS, Yun MJ, Kim MJ, et al. CT and PET in stomach cancer: preoperative staging and monitoring of response to therapy. RadioGraphics2006; 26(1):143–156. Link, Google Scholar5 GanpathiIS, So JB, Ho KY. Endoscopic ultrasonography for gastric cancer: does it influence treatment? Surg Endosc2006;20(4):559–562. Crossref, Medline, Google Scholar6 KimJH, Eun HW, Goo DE, Shim CS, Auh YH. Imaging of various gastric lesions: new CT techniques including 2D MPR and CT gastrography performed with multidetector CT. RadioGraphics2006;26(4):1101–1118. Link, Google Scholar7 KumanoS, Murakami T, Kim T, et al. T staging of gastric cancer: role of multi–detector row CT. Radiology2005;237:961–966. Link, Google Scholar8 InamotoK, Kouzai K, Ueeda T, Marukawa T. CT virtual endoscopy of the stomach: comparison study with gastric fiberscopy. Abdom Imaging2005;30:473–479. Crossref, Medline, Google Scholar9 van GelderRE, Venema HW, Serlie IW, et al. CT colonography at different radiation dose levels: feasibility of dose reduction. Radiology2002;224: 25–33. Link, Google Scholar10 IannacconeR, Laghi A, Catalano C, et al. Detection of colorectal lesions: lower-dose multi–detector row helical CT colonography compared with conventional colonoscopy. Radiology2003;229: 775–781. Link, Google Scholar11 ChenMY, Scharling ES, Zagoria RJ, Bechtold RE, Dixon RL, Dyer RB. CT diagnosis of acute flank pain from urolithiasis. Semin Ultrasound CT MR2000;21:2–19. Crossref, Medline, Google Scholar12 CarrascosaP, Capunay C, Ulla M, Lopez EM, Corti R, Carrascosa J. Elevated gastric lesions: virtual gastroscopy. Abdom Imaging 2005 Nov 28; [Epub ahead of print]. Google Scholar13 SvenssonMH, Svensson E, Lasson A, Hellstrom M. Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease. Radiology2002;222:337–345. Link, Google ScholarArticle HistoryPublished in print: July 2006 FiguresReferencesRelatedDetailsCited ByMaterials Science-Poland, Vol. 34, No. 1Recommended Articles CT Colonography: Improving Interpretive Skill by Avoiding PitfallsRadioGraphics2019Volume: 40Issue: 1pp. 98-119Early Gastric Cancers: Is CT Surveillance Necessary after Curative Endoscopic Submucosal Resection for Cancers That Meet the Expanded Criteria?Radiology2016Volume: 281Issue: 2pp. 444-453Machine Learning–based Differentiation of Benign and Premalignant Colorectal Polyps Detected with CT Colonography in an Asymptomatic Screening Population: A Proof-of-Concept StudyRadiology2021Volume: 299Issue: 2pp. 326-335Ligaments and Lymphatic Pathways in Gastric AdenocarcinomaRadioGraphics2019Volume: 39Issue: 3pp. 668-689Colorectal Findings at Repeat CT Colonography Screening after Initial CT Colonography Screening Negative for Polyps Larger than 5 mmRadiology2016Volume: 282Issue: 1pp. 139-148See More RSNA Education Exhibits CT Gastrography for Gastric Tumors: What is the Current Role?Digital Posters2018CT-Colonography is Here to Stay: Emerging Role of Pre-Operative CT-Colonography(CTC) in the Management of Patients with Stenosing Colorectal CancerDigital Posters2018Clinical Implementation of Dual-Energy CT for Bowel Disease: It's Time to Embrace the ChangeDigital Posters2018 RSNA Case Collection Gastric metastatic breast Cancer RSNA Case Collection2022Gastric Mucinous AdenocarcinomaRSNA Case Collection2021Stroke following CT guided chest biopsy RSNA Case Collection2020 Vol. 26, No. 4 Metrics Altmetric Score PDF download

Methylcellulose as a rectal contrast agent for MR imaging of rectal carcinoma.

available; and easy to prepare, administer, and store safely. We also needed an endorectal contrast material that had high enough viscosity to ensure adequate distention of the bowel and had signal characteristics that would maximize the contrast between the bowel wall and the contrast agent itself on T1- and T2-weighted images. We considered the use of water as a rectal contrast agent, but no formal evaluation was performed. The images of three patients who had water instilled as a rectal contrast agent clearly showed insufficient distention attributable to the low viscosity of water. Methylcellulose is a compound familiar to radiologists because of its use for double-contrast barium studies of the small bowel. A search through MEDLINE [7] revealed the first report of its usage in MR imaging in 1992, albeit as an upper gastrointestinal contrast agent [8]. The compound we used was a pharmaceutical-grade sodium salt of carboxymethylcellulose (BDH Laboratory Supplies, Poole, England). The compound comes in the form of granules, so adjusting the viscosity of the solution for optimal distention was easily done. We conducted a preliminary study to determine the optimal volume and concentration of methylcellulose. Exact viscosity measurements were not performed. Instead, concentrations by weight and volume were titrated using the guidelines given by the methylcellulose manufacturer. We found that the normal concentrations of 0.5‐1.0% used in small-bowel enteroclysis provided inadequate viscosity. We decided that solutions of 2.5%, 5%, and 7.5% were most likely to be suitable for our purpose. Solutions over 7.5%, such as 10%, were found to be too viscous to be easily delivered via a syringe; solutions with higher concentrations also resulted in severe clumping and inadequate distention. Therefore, we did not evaluate them. The carboxymethylcellulose was mixed in a ster

Radiographic imaging of inflammatory bowel disease

Radiographic imaging studies have an important role in the workup of patients with suspected IBD and in the differentiation of ulcerative colitis and Crohn's disease. Because of its ability to depict fine mucosal detail, the double-contrast barium study is a valuable technique for diagnosing ulcerative colitis and Crohn's disease even in patients with early disease. In contrast, cross-sectional imaging studies such as CT, MR, and ultrasound are useful for showing the effects of these conditions on the wall of the bowel and also for demonstrating intra-abdominal abscesses and other extraluminal findings in patients with more advanced disease. Thus, barium studies and cross-sectional imaging studies have complementary roles in the evaluation of these patients.

Giant Hyperplastic Polyps in the Stomach

We reassessed the radiographic findings of giant hyperplastic polyps in the stomach on double-contrast upper gastrointestinal examinations in seven patients. Giant hyperplastic polyps in the stomach may be manifested by distinctive findings on double-contrast barium studies, appearing as polypoid lesions with multiple lobulated components that form a conglomerate mass. Nevertheless, endoscopy and biopsy are required to rule out a polypoid carcinoma as the cause of these findings.

Radiological features of leiomyomatous tumors of the colon and rectum.

The purpose of this study was to evaluate the radiological features of 12 pathologically proven cases of colorectal leiomyomatous tumors. A retrospective analysis of radiologic findings was performed in 12 patients with pathologically proven colorectal leiomyomatous tumors (2 leiomyomas and 10 leiomyosarcomas). Available radiologic studies included abdominal CT scans in 11 patients, double contrast barium studies in 4, and pelvic MRI in 1. On imaging, we evaluated the size, tumor margin (smooth or lobulated), morphologic appearance, growth patterns (endocolic, exocolic, or combined), contrast enhancement patterns, presence or absence of calcification within the tumors, and metastasis. The involved tumor sites were the colon in 2 patients and the rectum in 10. The mean tumor size was 7.9 cm (range 2-15 cm): It was 3.5 cm in leiomyomas and 8.8 cm in leiomyosarcomas. On imaging studies, the tumor margin was smooth in three patients and lobulated in nine, with endocolic growth in one, exocolic in four, and combined in the remaining seven. Eight of the 12 tumors showed varying degrees of internal necrosis with heterogeneous contrast enhancement. Dystrophic calcification was noted in five patients. Metastasis was seen in the liver in three patients at the time of initial diagnosis, and lymphadenopathy was noted in two patients (paraaortic space in one and perirectal space in two). Although rare, the diagnosis of leiomyomatous tumor may be suggested especially when the tumor occurring in the colorectum shows exocolic growth or calcification with varying degree of internal necrosis.

Gastric adenoma with atypical appearance: findings on double-contrast barium study with histopathologic correlation.

To describe the radiologic findings of nonpolypoid gastric adenomas and to correlate them with pathologic findings. During a 9-year period, we reviewed 49 pure gastric adenomas in 43 patients with positive radiologic findings. Of these adenomas, seven with atypical polypoid appearance were retrospectively included in the study. We reviewed these findings with double-contrast barium study and correlated them with the pathologic findings. Of seven nonpolypoid adenomas, four were depressed and three were flat at pathologic examination. All were diagnosed as early gastric carcinoma (five as type IIc, one as type IIb, one as type IIa + IIc) in upper gastrointestinal series. Three were located in the gastric angle, two in the lower body, and two in the antrum. Size ranged from 10 mm to approximately 25 mm (mean = 15 mm). Six lesions had nodular surface and five had convergency of the mucosal folds. A shallow depressed area was seen in six lesions. A considerable proportion of gastric adenomas presents as a depressed or flat lesion on double-contrast barium study because of histologic characteristics of decreased subjacent mucosa. Because the nonpolypoid adenoma has a greater potentional for malignancy, more precaution is needed during the follow-up of this uncommon lesion.

Hypertrophied antral-pyloric fold: reassessment of radiographic findings in 40 patients.

To reassess the findings of a hypertrophied antral-pyloric fold on double-contrast barium studies. A search of radiologic files resulted in recovery of records of 1,796 patients with findings of antral gastritis on double-contrast upper gastrointestinal studies. According to radiologic reports, 40 patients had a hypertrophied antral-pyloric fold. The radiographs were reviewed retrospectively to determine the size, location, and morphologic features of the folds. Clinical, radiologic, and/or endoscopic follow-up data were obtained in 22 patients. All but two patients were symptomatic, and all but one responded to medical treatment. The hypertrophied antral-pyloric fold was located on the lesser curvature of the distal antrum in all patients and extended to the pylorus in 25 (62%) and into the base of the duodenal bulb in 15 (38%). The fold appeared as a smooth or slightly lobulated submucosal mass in 37 (92%) patients and as a plaquelike lesion in three (8%). Other radiographic findings of antral gastritis were present in 26 (65%) patients. In nine patients who underwent endoscopy, endoscopic and/or histologic findings of antral gastritis were present in five, but none had evidence of tumor. A hypertrophied antral-pyloric fold may be a sign of antral gastritis that is associated with characteristic radiographic findings. Endoscopy and biopsy may not be warranted when lesions with features typical of a hypertrophied antral-pyloric fold are seen on double-contrast barium studies.

Tumorous gastric varices: radiographic findings in 10 patients.

To determine the appearance of tumorous gastric varices on double-contrast barium studies and whether these varices have characteristic radiographic features. Review of radiology files revealed 86 patients with gastric varices diagnosed during double-contrast upper gastrointestinal tract examinations. Of these 86 patients, 12 (14%) had a conglomerate mass of varices, or tumorous varices. Five of the 12 patients had proved gastric varices and five were presumed to have varices on the basis of additional diagnostic test results, clinical follow-up findings, or both. Radiographs from these 10 patients were reviewed retrospectively to determine the size, location, and morphologic features of these lesions. Tumorous varices had a mean size of 6.8 cm (range, 3-11 cm). They involved the posteromedial border of the gastric fundus in eight patients, the central cardiac region in one, and the anterolateral-inferior fundal border in one. Viewed in profile, the varices appeared as smooth submucosal masses with undulating contours and discrete borders. Viewed en face, the varices manifested as a conglomerate of thickened, tortuous folds that faded peripherally into the adjacent mucosa. Tumorous gastric varices manifest as remarkably similar findings on double-contrast barium studies, usually appearing en face as a conglomerate of thickened, lobulated folds and in profile as smooth, undulating, submucosal masses on the posteromedial border of the gastric fundus. It is important to be aware of the characteristic features of tumorous gastric varices on double-contrast studies so that they are not mistaken for neoplastic lesions in the stomach.

Comparative features of double-contrast barium studies in patients with isosporiasis and strongyloidiasis

To compare the gastrointestinal features of isosporiasis and strongyloidiasis. Two patients with isosporiasis and three patients with strongyloidiasis were assessed by double-contrast radiography of the duodenum and small intestine, with reference to histology of the duodenal biopsy specimens. Both conditions affected the duodenum and the proximal jejunum, and showed similar radiographic changes as the diseases progressed. Thus, three patients with diarrhoea lasting 1 year or less showed only minimal or irregularly thickened mucosal folds, which seemed to result from mucosal inflammation. Two patients with long-standing disease periods (17 years and 30 years) presented a markedly granular mucosal appearance with effacement of the folds on radiography. These chronological differences in the radiographic features seemed to reflect the degree of villous atrophy. Isosporiasis has similar radiographic features of strongyloidiasis.

Carcinoma of the esophagus and esophagogastric junction: sensitivity of radiographic diagnosis.

The purpose of this study was to determine the sensitivity of barium studies in revealing carcinoma of the esophagus and esophagogastric junction. We retrospectively reviewed 50 cases of squamous cell carcinoma of the esophagus (n = 25) and adenocarcinoma of the esophagus (n = 14) or esophagogastric junction (n = 11) in which double-contrast (n = 46) or single-contrast (n = 4) barium studies had been done. The original radiology reports were reviewed to determine whether the lesions had been seen on barium studies and whether cancer had been diagnosed. Records were also reviewed to determine the number of patients who underwent esophageal endoscopy because of findings suggestive of cancer on barium studies at some point from January 1992 through December 1992. Pathology records were then reviewed to determine the number of true- and false-positive barium studies during this same period. Lesions were shown on barium studies in 49 (98%) of 50 patients, and carcinoma of the esophagus or esophagogastric junction was diagnosed or suspected in 48 patients (96%). In a separate part of the study, we found that endoscopy had been recommended to rule out malignant tumor in only 26 (1%) of 2484 patients who underwent barium studies at some point from January 1992 through December 1992. Endoscopy revealed cancer in 11 of those 26 patients; the remaining 15 were assumed to have false-positive radiologic examinations. Barium studies therefore had a positive predictive value of 42%. The double-contrast barium study is a sensitive technique for the diagnosis of carcinoma of the esophagus and esophagogastric junction. This high sensitivity can be achieved while recommending endoscopy in only about 1% of all patients who undergo barium studies.

Radiological prediction of the depth of invasion and histologic type in early gastric cancer.

In cases of early gastric cancer (EGC), the depth of tumor invasion and histologic type are important factors in its prognosis. To predict the depth of invasion and histologic type by a double-contrast barium study of the stomach, 304 consecutive patients with EGC were analyzed, comparing barium study with pathologic findings. We predicted the depth of invasion and histologic type according to the lesion size, surface pattern, and surrounding mucosal pattern. The depth of tumor invasion was correctly diagnosed in 65.3% (66 of 101) of cancers limited to the mucosal layer (m), and in 59.1% (110 of 186) of cancers which have invaded to the submucosal layer (sm). The histologic type was correctly predicted in 78.9% (56 of 71) of a differentiated adenocarcinoma, and 73.1% (57 of 78) of an undifferentiated adenocarcinoma. Prediction of the depth of tumor invasion and histologic type was promising and showed good correlation to the pathologic findings.

Barium studies in patients with Candida esophagitis: pseudoulcerations simulating viral esophagitis.

The purpose of this report is to describe an abnormality identified on barium studies in patients with Candida esophagitis that simulates discrete or aphthous ulceration. This finding may be misinterpreted as suggesting viral esophagitis. Between 1989 and 1993, four patients with endoscopically confirmed Candida esophagitis and no evidence of associated viral infection were treated at Hahnemann University. These patients were selected for study because double-contrast barium studies showed an "aphthoid" complex consisting of a superficial punctate barium collection surrounded by a thin radiolucent rim. Most of the complexes were 2-3 mm in diameter. No typical plaques were present, and the lesions were separated by normal mucosa. In two cases, only one or two lesions were observed on initial esophagograms because of limited distension. Additional esophagograms with additional distension showed more lesions. In two cases, the results of the barium studies were misinterpreted as evidence of viral esophagitis. Multiple esophageal lesions that resemble aphthous ulcers are a subtle radiographic manifestation of Candida esophagitis and may be responsible for either missed diagnoses or misinterpretation as viral esophagitis. Features suggestive of pseudoulceration include uniformity of size and relatively sharp margination of the filling defect, and punctate rather than stellate collections of barium.

Diagnosis of gastric carcinoma: sensitivity of double-contrast barium studies.

This study was undertaken to determine if the double-contrast upper gastrointestinal examination is a sensitive technique for diagnosing gastric carcinoma. We retrospectively reviewed the radiographs of 80 patients with pathologically proved gastric carcinoma who had double-contrast barium studies of the upper gastrointestinal tract between 1985 and 1992. The original radiologic reports were also reviewed to determine if the lesions had been detected on radiographic studies and if a diagnosis of gastric carcinoma had been made or suspected on the basis of the results. Subsequently, radiologic records were reviewed to identify all patients who had double-contrast studies during a recent 1-year period for whom endoscopy was recommended for evaluation of possibly malignant lesions. Pathologic records were also reviewed to determine the number of true-positive and false-positive cases in this group. The lesions were detected radiographically in all 80 patients. In one case, however, the lesion had been missed on another barium study 2 years earlier, so that we actually detected 79 (99%) of the 80 gastric carcinomas. Malignant neoplasm was diagnosed or suspected in 77 cases (96%). In two of the three cases in which gastric carcinoma was not mentioned in the radiologic reports, the lesion caused gastric outlet obstruction. A separate 1-year retrospective review revealed that only 54 (3.5%) of 1546 patients who had double-contrast studies during this period were referred for endoscopy because of radiographic findings that were equivocal or suggestive of tumor. The presence of gastric carcinoma was confirmed by endoscopy or surgery in 10 (19%) of those 54 patients. Our findings indicate that the double-contrast upper gastrointestinal examination is a sensitive technique for the diagnosis of gastric carcinoma. Furthermore, a high sensitivity can be achieved without having an inordinate number of patients undergo unnecessary endoscopy.

Angiography is useful in detecting the source of chronic gastrointestinal bleeding of obscure origin.

The treatment of patients with chronic gastrointestinal bleeding can be a frustrating diagnostic challenge. In the past 10-15 years, a variety of new diagnostic procedures (e.g., fiber-optic endoscopy, scintigraphy, and double-contrast barium studies) have become available to examine these patients. Despite these new procedures, a small number of patients continue to bleed without a defined cause. We sought to evaluate the role of visceral angiography in patients with chronic gastrointestinal bleeding in whom findings on an extensive noninvasive workup have been normal. Between 1983 and 1990, we obtained angiograms on 36 such patients. The cause of bleeding was established by angiography in 16 patients (44%). In 11 of these 16, angiography revealed only a structural abnormality without active bleeding. Twenty patients had normal angiographic findings. No angiograms were false-positive, but three were false-negative (8%). No complication occurred as a result of the angiographic procedures. Our experience shows that visceral angiography can provide a positive diagnosis in a significant number of patients with chronic gastrointestinal bleeding of obscure origin in whom all other diagnostic measures have been unrevealing. Despite improvements in noninvasive diagnostic techniques, angiography still remains an important tool for examining this group of patients.

Visualization of the mucosal villi on double-contrast barium studies of the small intestine by using a high molecular fraction of guaran

Guaran is a water-soluble polysaccharide from the seed endosperm of Cyanopsis tetragonolobus. A high molecular fraction of guaran, when added to barium, enhances barium coating of the intestinal mucosa. This study reports its use to demonstrate the mucosal villi of the small intestine during double-contrast barium examination in the rat and in the human. In the animal model, individual villi were identified surrounded by pools of barium. In the human, a granular pattern caused by the villi was seen. Individual villi were visible with high-definition radiography. This was confirmed by microscopic studies of biopsy specimens in which the villi were shown to have the same diameters as the structures seen on high-definition radiography.

Radiological appearances following vertical banded gastroplasty

Vertical banded gastroplasty was performed on 19 grossly obese patients. Upper gastrointestinal contrast studies were performed on all patients in the immediate post-operative period and at 3 months and 1 year in 16 and 12 patients, respectively. The immediate and long-term appearances are presented and discussed. The surgical outcome depends on pouch size, outlet diameter and staple line integrity, which are reliably demonstrated by double-contrast barium studies.