Indication for Contrast GI studies:

• Done to assess either for acute or chronic complications
   
• A) Acute Complications:
  • Anastomotic leak
  • Anastomotic stenosis
     
• B) Chronic Complications:
  • Stomal ulcer
  • Bile gastritis
  • Outlet obstruction (benign or malignant)
  • Adenocarcinoma in gastric remnant
  • Retrograde jejuno-gastric intussusception
     

Technique:

• The study should be done mostly in double contrast phase especially of the gastric remnant, the afferent and efferent limbs.
   
• The main purpose is to assess the gastric remnant and the anastomosis in double contrast as well as possible.
   
• The esophagus can be examined later during the study except if there is an obstructing oesophageal lesion.
   

Radiographic Images:
 

• Scout AP view of Stomach:
   
  • To assess inherent fluid level in gastric remnant this will suggest some element of outlet obstruction
     
• AP views of Stomach after first barium swallow:
   
  • To check which of the two limbs (afferent or the Efferent limb) fills first
  •  Efferent limb should fill first since it is more dependent (created surgically)
     
• Give effervescent granules followed by barium
  • Place the patient in SUPINE position
  • Turn patient to right and left sides to fill the afferent and efferent limbs (respectively) with barium and air
     
•  Radiographic Images of the Stomach:
   
  •  Supine
    • (survey view of gastric remnant and afferent & efferent limbs)
    • Right Lateral (Fundus in double contrast)
    • Left Lateral (Gastro-jejunal anastomosis)
    • Right and Left Oblique views (to obtain double contrast views of the Efferent limb and Afferent limb (respectively)
       
  • Prone View
    • Double contrast view of fundus and single contrast of the two limbs
       
  • Upright Views: These views again will better assess the gastric remnant and the anastomosis in double contrast
    • AP view Right Oblique
    • Left Oblique
    • Lateral view
       
• Esophageal Views:
   
  • These views can be done initially but not at the expense of gastric remnant and the anastomosis which are the most important part of the entire study.
  • The esophagus can be examined at the end of the study. Unless if there is esophageal obstruction noted on clinical history or during the study.
  • Can also do the semi-prone cine esophageal peristalsis study.
  • See UGI for technique details