Barium Swallow vs. Endoscopy: What’s the Difference?

Two procedures used to examine the digestive tract are a barium swallow and an endoscopy. While they are related in their goal of helping your doctor assess areas and structures that cannot be viewed externally, they are very different processes.

Barium Swallow vs. Endoscopy for Upper GI Problems

The main advantage of a barium swallow is that it is less invasive because it’s a special type of x-ray. While many patients report that swallowing the barium is unpleasant, no instruments are inserted into the body. An endoscopy is a more invasive procedure, but it enables a doctor to immediately see the structures or areas of interest and to take actions such as removing tissue for biopsy.

Both barium swallow and endoscopy are typically outpatient procedures, meaning you can go home the same day. Each has side effects that are generally mild. These include constipation with a barium swallow and a sore throat with an endoscopy. In both procedures, the side effects tend to resolve on their own with proper aftercare such as hydrating and eating high-fiber foods after a barium swallow and eating soft foods after an endoscopy.

What Is an Endoscopy?

An endoscopy is a procedure that allows surgeons to see problems inside your body without having to make large incisions. In the case of an upper GI endoscopy, a specialized flexible tube with a light and camera attached to it is inserted through your mouth and down into your GI tract. This allows your doctor to see specific areas. Scissors and forceps on the tool allow the doctor to remove tissue for examination if appropriate.

Your doctor may order an upper GI endoscopy if you have symptoms or conditions such as:

  • Stomach ulcer
  • Bleeding in the digestive tract
  • Gastroesophageal reflux disease (GERD)
  • Tumors
  • Infections the esophagus
  • Hiatal hernia

What Is a Barium Swallow?

A barium swallow is an X-ray procedure in which you swallow a chalky, white substance called barium that is typically a thick drink with the consistency of a milkshake. This exam is used to provide images of what is called your upper gastrointestinal (GI) tract. This includes your pharynx (the back of your mouth and throat), esophagus (the tube that starts behind your tongue and runs down to your stomach), stomach and the first part of your small intestine, which is called the duodenum.

The barium coats the surface of your upper GI tract and appears white on X-rays. The procedure produces detailed images of the linings of the tract and can provide insight on the motion of your swallowing.

A barium swallow can help diagnose a number of conditions, including:

  • Cancerous and noncancerous tumors
  • Inflammation
  • Blockages
  • Ulcers
  • Gastroesophageal reflux disease (GERD)
  • Hiatal hernia
  • Muscle disorders that cause spasms or problems with swallowing

After your exam, you are free to return to your normal activities and usual diet unless told otherwise by your physician.  Barium may cause constipation and it is normal for the barium to give a whitish color to your stool for the next day or two. You will need to increase your water intake and possibly take a mild laxative in order to clear the barium from your system within a day or two of your exam. If you have trouble with constipation normally, you should consult your physician for a specific treatment plan.

After your study is completed, the radiologist will interpret your images and send a written report to your physician. Your physician will review the results of the exam with you at your next scheduled appointment.

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