Special Procedure: Upper Gastrointestinal (GI) Series
Barium (in some cases, iodine-based) contrast is administered into the stomach via orogastric or nasogastric intubation. The patient is generally initially imaged with fluoroscopy to evaluate gastric motility and pyloric function, and then a series of static images are taken. The exact timing and duration of the study will vary with the initial findings.
Indications for this procedure :
- Assessment of the size, shape, and position of the stomach and small intestine.
- Evaluation for suspected foreign body or other causes of mechanical ileus.
- Investigation of gastric outflow abnormalities including gastric foreign bodies acting as a "ball valve", pyloric hypertrophy and neoplasia.
- Investigation of gastrointestinal motility.
- Evaluation of the mucosa and wall of the stomach and small intestine.
Contraindications, considerations and complications for this procedure :
- Opioid medications such as commonly used for pain management and restraint can have marked effects on GI motility and should be avoided.
- The patient should be fasted for 18-24 hours prior to the procedure as the presence of food in the stomach can obscure lucent foreign material and other lesions, and complicates the interpretation of gastric emptying time.
- The patient must have an enema to clear the colon of fecal material (with the exception of emergent cases) which can obscure evaluation of the small intestine as well as delay gastric emptying and small intestinal transit time. The enema will be performed at the VMC on the morning of the procedure.
- Aspiration is a very rare complication as we administer contrast by gavage and verify tube location under fluoroscopy. However, if the patient vomits, aspiration may occur. Barium contrast is not toxic to the airway, although bacterial contamination with GI or oral flora may result in pneumonia. Ionic iodine contrast can cause fatal pulmonary edema and is avoided in patients considered at significant risk for emesis. Non-ionic iodine contrast agents are used in patients who are at risk for both emesis and are suspected of having a perforation.
- If a GI perforation is suspected, iodine contrast will be used. If there is a perforation present that was not suspected, however, barium leakage into the peritoneum could occur.