The routine double-contrast examination of the esophagus.

Double-contrast examination of the esophagus can be carried out routinely on most patients referred for an upper gastrointestinal examination. Although there are several methods of performing the examination, this author has found the use of effervescent solutions and a low-viscosity barium sulfate suspension to be the easiest and quickest. The technique leads directly into a subsequent double-contrast examination of the stomach. Routine views of the esophagus in a single projection are sufficient with the double-contrast method in most patients. Lesions are readily identified both en face and in profile. If a suspicious area is seen or the patient has dysphagia, multiple views can subsequently be obtained. Such esophageal lesion characteristics are size, smoothness, irregularity, ulceration, wall retraction, and distensibility can be readily appreciated. The technique also lends itself to the study of hiatal hernias and the gastroesophageal junction. This double-contrast esophageal technique has been used with no complications in over 4000 examinations. It is readily mastered by beginning residents.