Upper GI double contrast

  • Patient preparation: do not perform on a child less than 12 years old, NPO 4 hours
  • Contrast used: barium and crystals
  • Technique and Images to obtain:
    — Start with patient upright
    — AP fluoroscopy of chest and diaphragm
    — AP – image of esophagus while swallowing
    — Left posterior oblique – image of esophagus while swallowing
    — Patient finishes barium
    — AP – image of upright filled stomach
    — Give patient crystals and tell them to swallow, swallow, swallow to prevent belching
    — Tilt table down
    — Patient to turn away from you supine – left lateral – prone – right lateral – supine
    — Supine – image of lower body / antrum
    — Right lateral – image of cardia and fundus
    — Check for gastroesophageal reflux
    — Right posterior oblique – image of upper body
    — Left posterior oblique – image of antrum / bulb / duodenal C-loop
    — Turn towards you to right anterior oblique
    — Right anterior oblique – image of filled antrum / bulb / duodenal C-loop
    — Check for hiatal hernia and Schatzki ring
    — Right anterior oblique with swallow – image of lower esophagus / gastroesophageal junction
    — Tip upright
    — Left posterior oblique – image of fundus
    — Left posterior oblique – images of body / antrum / bulb
    — Tip down
    — Left posterior oblique – compression images of body / antrum / bulb / Ligament of Treitz
    — Prone overhead image
  • Looking for: mucosal lesions
  • Post procedure tasks: advise patient to drink plenty of liquids to wash barium out of system and that barium will lighten color of stools