Upper GI for esophageal atresia with H-type tracheo-esophageal fistula or recurrent tracheo-esophageal fistula

  • Patient preparation: none
  • Contrast used: first use low osmolar water soluble or iso osmolar water soluble and then barium, never use high osmolar water soluble because if aspirated it can cause severe pulmonary edema
  • Technique: do the exam in left lateral and left anterior oblique positions, begin by giving contrast by mouth and see if the patient can adequately distend the esophagus in this manner, if the patient cannot adequately distend the esophagus with contrast taken by mouth insert an 8 French feeding tube into the distal esophagus and distend the esophagus with contrast injected through the tube checking carefully for a fistula, if no fistula is seen pull the tube back a few centimeters and repeat until you have reached the proximal esophagus
  • Images to obtain: AP and lateral images of the esophagus at each level of injection
  • Looking for: H-type tracheo-esophageal fistula
  • Post procedure tasks: failure to demonstrate a H-type tracheo-esophageal fistula does not mean one does not exist so if the patient’s symptoms persist repeat the study in 1-2 months