Pediatric upper GI for vomiting or gastroesophageal reflux

  • Patient preparation: NPO for 4 hours
  • Contrast used: barium taken by mouth or nasogastric tube
  • Technique:
    — Before beginning exam pull any nasogastric tube present up into the esophagus as a nasogastric tube can stent open the gastroesophageal junction and induce gastroesophageal reflux
    — With the patient supine, observe the motion of the diaphragm, especially in post surgical patients
    — Put the patient in the left lateral position, give the patient barium, take a lateral image of the esophagus
    — Put the patient in the supine position, give the patient barium, take a supine image of the esophagus
    — Put the patient in the right lateral position to empty the stomach and take a lateral image of the duodenal sweep
    — When contrast is seen to enter the 3rd/4th part of duodenum, turn the patient supine and document the position of the duodenal-jejunal junction with an AP image
    — Move the patient from right to left lateral and back again to attempt to induce gastroesophagel reflux (Note if you are using a nasogastric tube for the exam, pull it above the gastroesophageal junction before checking for reflux)
  • Images to obtain: AP image of the esophagus, left lateral image of the esophagus, right lateral image of the duodenal sweep, AP and lateral images of the stomach and any abnormalities in it, AP image of the duodenal-jejunal junction, image of gastroesophageal reflux if present to document how high it goes
  • Looking for: gastroesophageal reflux and if present describe how high it extends up into the esophagus, gastric outlet obstruction, hypertrophic pyloric stenosis, malrotation, midgut volvulus, duodenal stenosis, jejunal stenosis
  • Post procedure tasks: aspirate the stomach at end of exam if feeding tube still in place, advise patient to drink plenty of liquids to wash barium out of system and that barium will lighten color of stools