Barium Studies

BARIUM STUDIES—UPPER GASTROINTESTINAL TRACT

Double-Contrast Upper Gastrointestinal Tract Series (Table 56.1)

Indications.

Possible indications include (1) dyspepsia, (2) weight loss, (3) upper abdominal mass, (4) gastrointestinal (GI) hemorrhage, and (5) partial upper GI obstruction.

Contraindications.

Complete large bowel obstruction.

Patient Prep.

NPO for 6 hours.

Premedication.

Some radiologists use glucagon 0.1-0.3 mg IV, given slowly over 30 seconds, p.r.n to slow gastric emptying.

Caution.

Use water-soluble iodinated contrast if perforation is suspected. Use nonionic water-soluble contrast if aspiration is also likely. Nonionic contrast agents are less likely than Gastrografin to cause chemical pneumonitis if aspirated.

Single-Contrast Upper Gastrointestinal Tract Series

(Table 56.2)

Indications.

Indications for this study are essentially the same as for the double-contrast study. Advantage: requires less patient mobility. Disadvantage: purely mucosal lesions are not well visualized.

Contraindications.

Complete large bowel obstruction.

Patient Prep.

NPO for 6 hours.

Premedication.

See double-contrast study.

Caution.

Pediatric Upper Gastrointestine Series

(Table 56.3)

Indications.

In the pediatric population, the common indications include major causes of persistent vomiting: (1) gastroesophageal (GE) reflux, (2) pyloric obstruction, (3) GI malrotation.

Patient Prep.

NPO for 4 hours if less than or equal to 2 years old; NPO for 6 hours if older than 2 years.

TABLE 56-1 Double-Contrast Upper Gastrointestinal (GI) Protocol^a

Start
Standing		Give: gas pills, water; fluoro for position; drink 2-3 gulps thick barium (hold cup in L hand near L shoulder)
Spot filming—thick barium
Stand	LPO	– 2/1 air esophagram (include gastroesophageal junction [GEJ]), two exposures
Coat		– Finish at least 3/4 of barium, face table, bring table down with patient prone, then position L lateral, then supine.
Supine	AP	– 1/1 body stomach (in air)
	LPO	– 1/1 antrum stomach (in air); try air bulb^b
	RPO	– 1/1 Schatzki view and body stomach (include lesser curve)
R lateral		– 1/1 anterior wall and GEJ (in air) and duodenal bulb
Prone	PA	– 1/1 body and antrum stomach (over bolster)
	RAO	– 2/1 antrum, bulb and C-sweep (with compression)
[L lateral]^b
Spot filming—thin barium
Prone	RAO	Fluoro: observe single big swallow of thin barium from thoracic inlet to GEJ; observe stripping wave
		2/1 drinking esophagram [over bolster] (include GEJ), two exposures
Supine	AP	Check for GE reflux, document level if present
[Supine LPO]^b
Stand	LPO	1/1 fundus stomach^b
		4/1 bulb, antrum (with compression), two exposures
	AP	4/1 proximal and distal stomach (with compression), one to two exposures
Finish up
		Overheads: routine
^aSpot film (9″ × 9″) formats:
^b2/1 Opportunities to image the duodenal bulb in air (“air bulb”); make two exposures (include antrum and bulb, then bulb and C-sweep). (Trick: Try turning patient prone LAO to drain excess barium from the duodenal bulb and to fill it with air; then turn patient back to supine LPO for spot film.)

TABLE 56-2 Single-Contrast Upper GI Protocol^a

Spot filming
Prone	RAO	– 2/1 drinking esophagram (include GE junction)
		– 1/1 or 2/1 gastric antrum; duodenal bulb and C-sweep ± compression paddle
Supine	RPO	– 1/1 Schatzki view and GE junction
		– [4/1] [duodenal bulb in profile]
Supine	AP	– 1/1 stomach
		– Check for GE reflux
Semierect		– 4/1 stomach quadrants with compression
		– [1/1] [gastric fundus and GE junction in air]
Supine	LPO	– 1/1 or 2/1 duodenal bulb and gastric antrum in air (attempt)
^aSpot film (9″ × 9″) formats:

TABLE 56-3 Pediatric Upper GI Protocol^a

Start
Be especially attentive to collimate as much as possible. A rough outline is given in the subsequent text; pediatric studies are usually highly tailored for the clinical question.
Position	Film	View/Maneuver
L lateral and supine AP	2/1	Drinking esophagram Allow stomach to empty; try not to overfill stomach to avoid obscuring ligament of Treitz later in examination
R lateral or supine RAO	4/1	Duodenal bulb Follow contrast (starting from stomach on lateral view, show contrast moving slightly superiorly to duodenal bulb, then inferiorly in second portion duodenum)
Supine AP	1/1	Stomach, C-loop, and ligament of Treitz (show contrast crossing to left of midline) Fill stomach fully, look for GE reflux (child should not be crying) Consider water siphon test if study is to rule out GE reflux
Finish up
Overhead: consider one AP abdominal film afterwards for an overall picture of the upper GI tract, including the proximal small bowel.
^aSpot film (9″ × 9″) formats: