What are the common indications of upper GI?
eval of dyspepsia, GERD, or recurrent vomiting
assessment of peptic ulcer disease or gastric outlet obstruction
identification of hiatal hernia, esophageal or gastric mass
detection of congenital anomalies (malrotation, pyloric stenosis in infants)
post op assessment (gastric bypass, fundoplication, anastomotic integrity)
screening for gastric emptying abnormalities and motility disorders
Absolute contraindications?
suspected GI perforation (use water-soluble)
severe dysphagia with aspiration risk (consider MBS study)
unstable patients unable to tolerate positional changes
What are relative containdications?
known severe contrast allergy
bowel obstruction (barium can cause impaction)
Required equipment (fluoroscopy and contrast supplies)
fluoroscopy unit
barium sulfate suspension (low-density for motility, high-density for mucosal evaluation)
water-soluble contrast is perf is suspected
effervescent granules (to distend stomach for double-contrast study)
Pre-procedural prep
NPO for 6-8 hours prior to study to ensure an empty stomach
pick contrast:
single contrast study: standard barium for routine eval
double contrast study: barium + effervescnet granules for detailed mucosal assessment
water soluble if perf is suspected
explain swallowing instructions and warn about possible bloating from granules
Why are AP and lateral scout images taken before contrast ingestion?
to assess baseline anatomy and bowel gas patterns
Step two in protocol is contrast swallowing dynamic eval under fluoro. what is the patient positioning?
upright (preferred) for initial eval
supine or prone for detailed stomach and duodenal assessment
Why is the swallowing of barium captured during real-time fluoro?
to eval esophagus, stomach and duodenum
What is the AP view used for?
evals gastric contour, hiatal hernia, or ulcerations
What is the lateral view used for?
it is upright or left lateral
assesses posterior wall of stomach, esophageal reflux, or pyloric function
What is the RAO view and what is its purpose?
patient is 40-60 degrees
improves visualization of pylorus and duodenal bulb
What is the purpose of the supine view?
identifies gastric outlet obstruction or delayed gastric emptying
What is the purpose of the trendelenburg position?
provocative test for gastroesophageal reflux or hiatal hernia
How do you evaluate the duodenal and pylorus?
patient drinks additional barium to assess gastric emptying and pyloric function
observe contrast flow into the duodenum and jejunum for obstruction or delayed emptying
What modifications would you make if there was a suspected perforation?
use water-soluble contrast instead of barium
What modification would you make to assess for reflux?
use trendelenburg positioning or water siphon test
What modification would you make if there was delayed gastric emptying?
monitor contrast passage into the small bowel over time
What modifications would you make if there was pyloric stenosis (infants)?
eval thickened pyloric muscle and delayed emptying
How would hiatal hernia look on imaging and what is it associated with?
gastric fundus above diaphragm
associated with GERD
How would gastric ulcer look on imaging on what is it associated with?
crater-like lesion with contrast pooling
risk of perforation or bleeding
How would esophageal reflux (GERD) look on imaging and what is it associated with?
retrograde flow of contrast into the esophagus
can lead to Barrett’s esophagus
How would pyloric stenosis look on imaging and what is it associated with?
string sign or elongated narrowed pylorus
common in infants with vomiting
How would gastric outlet obstruction look on imaging and what is it caused by?
delayed emptying or dilated stomach
could be due to tumor or scarring
What is considered diagnostic success?
clear contrast movement through the esophagus, stomach, and duodenum without obstruction
accurate identification of ulcers, hernias, structures, and motility disorders
provocative tests for reflux yield expected findings
