Fluoroscopy Upper GI Study

Roughly, the recommended fasting time before the study is equal in length to the regular time between meals for the patient, being longer in adolescents than in newborn babies. Typically in children under 1 year of age, a 3-h fasting period is sufficient to empty the normal stomach. A longer fasting time bares the risk of dehydration in this patient group. Older children will be kept fasting overnight (Sohlesinger and Parker 2003).

Traditionally barium will be used as contrast agent. However, in a patient with suspected risk of aspiration (e.g. neurologically impaired children) or a neonate with a congenital proximal obstruction and suspicion of perforation (risk of barium peritonitis), non-ionic low-osmolar contrast agents will be used. The main advantages of the latter contrast agents are lack of large fluid shifts, absence of con

Fig. 3.2. a Radiograph with air as contrast agent: malrotation. b Radiograph with high density contrast agent: confirmation of malrotation. (Courtesy of Dr. Carlo Buonomo, Boston, MA, USA)

Fig. 3.2. a Radiograph with air as contrast agent: malrotation. b Radiograph with high density contrast agent: confirmation of malrotation. (Courtesy of Dr. Carlo Buonomo, Boston, MA, USA)

trast dilution, lack of injury to the bowel mucosa, low absorption from the bowel and relatively low risk of pulmonary edema if aspirated.

An upper GI study will always include the evaluation of the esophagus, stomach and duodenum.

An upper GI study in newborns and small infants will be different from those performed in adolescents. In the former group of children, the study will be performed to evaluate a (known) congenital proximal obstruction (evaluation of antral or duodenal web) or, more importantly, to evaluate the position of the duodenojejunal flexure (the ligament of Treitz). The study will be tailored to answer these specific questions and these will always be single contrast studies. In older children, however, double contrast studies may occasionally be necessary depending on the clinical question (e.g. polyps).

On barium studies, the contour of the stomach typically will appear smooth in newborns and young infants, while in older children the normal gastric rugal folds will be visible as seen in adults.

Pulsed fluoroscopy is always recommended in children together with careful collimation and gonadal shielding. Furthermore, photo spot-film cameras or digital fluoroscopy should be used (Schlesinger and Parker 2003).

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