Single Contrast Esophagram Views:
The patient is positioned Upright and in the Left Posterior Oblique (LPO) position for the esophagogram.  The patient is asked to drink a small volume of high density barium (e.g. EZHD) and a single contrast view is done. This initial view is done to ensure there is no large obstructing lesion present prior to giving the effervescent granules.	Single contrast: A small bolus of barium is given.

 

Effervescent Granules:
The patient is then given 1 packet of gas granules followed by ONLY 15 cc of water.

 

Double Contrast Esophagram Views:
The patient is asked to drink the rest of the barium continuously. Views of the entire esophagus in double contrast are taken from the cervico-thoracic junction to the esophago-gastric junction. The esophago-gastric junction area is imaged at 9” FOV to assess fine detail. The double contrast views are necessary especially for reflux disease (i.e. detecting early signs of esophagitis, etc).

 

Coating the Stomach:

The patient is placed in the PRONE (facing the table) position and the table is brought down. This will allow for better coating of the anterior wall of the stomach. To coat the rest of the stomach, the patient does the ‘log roll’ (i.e. the patient is turned from prone onto the left lateral decubitus position, followed by supine, right lateral, prone then left lateral decubitus and finally supine position). This maneuver will keep all the barium in the fundus.

 

AP View of the Stomach:
	This view is for the stomach (double contrast of the antrum & body, single contrast of the fundal region). Both 16 & 12 “FOV views are taken.

 

Left Posterior Oblique View of the Gastric Antrum:
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The patient is then placed in a Left Posterior Oblique (LPO) position. This view allows you to visualize the gastric antrum and the duodenal cap while being able to sweep in double contrast phase.	Double contrast image of the gastric antrum taken on 9" FOV.

 

Right Posterior Oblique Views of the Lesser & Greater Curvatures:
	This view is taken to assess the lesser and greater curvatures of the body of the stomach. This view splits the barium into two portions – one in the fundus and the second in the antrum. This view allows the maximum evaluation of the two curvatures in double contrast.

 

Right Lateral Decubitus Views of the Gastric Fundus (Double Contrast):
With the patient in the Right Lateral Decubitus position, a view of the gastric fundus in double contrast is taken first on 16” FOV followed by 12” FOV. This traps the air and gives one of the better images of the fundus (before patient has the urge to burp).

 

Right Semi-Prone Oblique Views of the Doudenal Cap (Single Contrast):
One must take at least two or three views of the duodenal cap in different projections and angulations.

 

Prone View of the Entire Stomach & Duodenum:
	This view is like the ‘compression’ of the antrum in single contrast. The fundus is in double contrast and the duodenal sweep is sometimes seen to a better advantage.

 

Left Lateral Decubitus View of the Anterior Stomach Wall:
The patient is then turned to the Left lateral Decubitus position. This view will provide a double contrast view of the anterior wall of the stomach and sometimes of the posterior portion of the fundus.	NOTE: There is a lesion on the anterior wall of the stomach (arrow)

 

Left Posterior Oblique View of the Duodenum (Double Contrast):
	The patient in LPO position will demonstrate the duodenal cap and the rest of the duodenum in double contrast. You may have to angle the X-ray tube and/or the patient to get a clear view of the duodenum. A minimum of two-three views are taken.

 

Supine View of the Entire Stomach & Duodenum:
With the patient in Supine position, a final view of the gastric body and antrum (in double contrast) and the duodenal sweep (single contrast) is taken.	The final image is taken of the entire stomach including views of barium filled duodenal sweep up to the ligament of Treitz

 

Drinking Esophageal Peristalsis View:
This view is taken with the patient in a semi-prone position with the left arm by the side and right hand used for holding the drinking cup. The patient drinks Polibar 100% quickly and a cine esophagogram from the cervical to the esophago-gastric junction is taken (using ‘last image hold at 2 frames fluoroscopic image) and 16” FOV. One may do this view early if there is pyloric spasm.

 

Upright Gastric & Duodenal Views:
	This view is taken to assess the distensibility of the antrum (in single contrast with the weight of barium) and double contrast views of the fundus. For the fundus, oblique & lateral views may be helpful.