28.1 Barium swallow – oesophageal cancer (barium is white)
There is an irregular circumferential filling defect with ‘shouldering’ (*) from normal mucosa to abnormal mucosa. These are typical barium swallow features of oesophageal cancer and confirmed with endoscopy and biopsy
Normal peristalsis was absent in this patient. There is a narrowing of the lower oesophageal sphincter (LOS; arrowhead) and luminal dilatation above this level
Numerous diverticula (arrowheads) in the sigmoid colon have filled with barium. The lumen is distended by pumping gas (CO2 or air) into the rectum. No complications of diverticular disease such as stricturing are seen in this patient
28.4 Double-contrast barium enema (DCBE) – apple core lesion due to colorectal cancer (barium is white)
There is a circumferential irregular narrowing (between arrows) of the colonic lumen. This has the appearance of an apple core. Sigmoidoscopy and biopsy confirmed an adenocarcinoma
- Webs and rings – a web is a thin expansion of normal oesophageal tissue composed of mucosa and submucosa projecting into the lumen. A ring is a circumferential extension of normal oesophageal tissue containing mucosa, submucosa and muscle. Either can present with pain and dysphagia. Webs are commonest in the upper oesophagus and may be associated with Plummer-Vinson syndrome (web and iron deficiency anaemia) and can develop into carcinoma. Rings are more prevalent in the lower oesophagus, the commonest being the Schatzki ring (histologically a web since it contains only mucosa and submucosa). Barium swallow is an alternative option (to the first-line investigation of endoscopy) in patients presenting with dysphagia as well as those with a suspected web or ring.
- Oesophageal stricture – this is a fixed narrowing of the oesophageal lumen and may be classified into three groups.