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Barium Studies of the Upper Gastrointestinal Tract
Upper gastrointestinal (GI) tract barium studies can be performed by single- or double-contrast technique. Single-contrast study relies primarily on barium filling and mucosal relief, whereas the double-contrast study is actually a biphasic technique that combines the advantages of single and double contrast. This chapter describes a reasonable approach for performing both types of studies, with emphasis on double-contrast examination because of its superior diagnostic capabilities. ,
General Principles
Single-contrast upper GI studies rely on barium filling of the distended lumen to assess for contour abnormalities and mucosal relief of the collapsed lumen to assess for filling defects and barium collections in the thinned-out barium pool. In contrast, double-contrast upper GI studies are designed to coat the mucosa with a thin layer of high-density barium while the lumen is distended with gas. Both examinations include the esophagus, stomach, and duodenum to the duodenojejunal junction. For double-contrast studies, the examination should be performed quickly to maintain optimal mucosal coating and prevent barium filling of the duodenum and small bowel from obscuring the stomach. The technical details of the examination should be tailored based on the patient’s presenting symptoms, the anatomic configuration of visualized structures, and specific abnormalities observed at fluoroscopy.
Double-Contrast Upper GI Study
BARIUM SUSPENSIONS
High-density barium (250% w/v) is employed for double-contrast studies. The preparation of the barium suspension is critical because slight deviations in concentration may impair mucosal coating quality and create artifacts.
EFFERVESCENT AGENTS
Various effervescent agents are administered in powder, granular, or liquid form. These agents release 300 to 400 mL of carbon dioxide on contact with fluid in the stomach.
HYPOTONIC AGENTS
A hypotonic agent relaxes the stomach and duodenum, facilitating luminal distention and mucosal coating. In the United States, the most suitable hypotonic agent is glucagon (0.1 mg; intravenously [IV]), which produces transient gastric hypotonia. This hypotonic effect may delay barium filling of the duodenum for several minutes, prolonging the examination.
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