Dr. David DiSantis, a radiologist at the Mayo Clinic in Jacksonville, Florida, and colleagues looked at Medicare yearly procedure volumes from 2000 through 2019 for the most common GI fluoroscopy procedures, including esophagrams, swallowing studies, upper GI exams, small bowel follow-throughs, and barium enemas.
"What are the numbers telling us? There is barium work still being done, but there's been a definite shift -- now the work we do is primarily above the diaphragm," DiSantis said.
The importance of fluoroscopy as an imaging modality has dropped relative to other cross-sectional modalities, such as high-resolution CT, MRI, and ultrasound due to a lack of appreciation of its usefulness, insufficient training of residents, fewer staff with adequate expertise, and poor reimbursements, according to DiSantis.
Image courtesy of Dr. David DiSantis.
However, in 2019, there were 2.9 million fluoroscopy procedures performed in the U.S. DiSantis and colleagues aimed to analyze trends to identify which studies are still performed in significant volume as a guide for matching trainee education with current practice.
All procedure volumes dropped, DiSantis said. Yet the degree of change was extremely disparate.
The analysis found swallowing studies were down just 4%, esophagrams fell 11%, single-contrast upper GIs dropped 65%, double-contrast upper GIs fell 77%, single-contrast barium enemas plunged 89%, and double-contrast barium enemas plummeted by 95% to just a few thousand from a peak of more than 600,000 in 2000.
"Fluoroscopy training should focus above the diaphragm, stressing mastery of swallowing studies and esophagography," he said.
DiSantis noted that with an aging population, dysphagia is increasing and that means barium studies may also increase. At the very least, the American Board of Radiology should ask trainees about swallowing and esophagrams on exams because if you don't ask them, they'll think they don't need to know it, he said.
"These data allow radiology training programs to match fluoroscopy instruction with the real-world clinical demand that their graduates will face," DiSantis concluded.
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