RadteraUpper GI Series (UGI)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Epigastric pain / dyspepsia
- Suspected peptic ulcer disease
- Gastric or duodenal mass/carcinoma
- Gastric outlet obstruction
- Postoperative evaluation (e.g., bariatric, fundoplication, gastrectomy — use water-soluble for leak)
- Hiatal hernia / reflux
- Unexplained nausea/vomiting
Patient prep
- NPO at least 6-8 hours (NPO after midnight typical)
- No smoking or gum chewing (increases secretions/motility)
- Hold certain motility-altering meds per protocol
- Remove abdominal radiopaque objects
Contrast
AgentHigh-density barium sulfate plus effervescent gas crystals for double-contrast; thin barium for single-contrast; water-soluble iodinated agent if leak/perforation or recent surgery
Routeoral
DoseEffervescent crystals (CO2) followed by high-density barium, then thin barium as needed
TimingReal-time fluoroscopy through esophagus, stomach, and duodenum
Technique
- Optional glucagon IV (0.1-0.5 mg) to reduce peristalsis for double-contrast detail (if no contraindication)
- Effervescent crystals then high-density barium; rotate patient to coat gastric mucosa
- Double-contrast spot films of stomach in multiple obliquities (supine RPO/LPO, upright)
- Prone/RAO single-contrast (full-column) compression views of antrum and duodenum
- Image duodenal bulb and C-loop in multiple projections
- Reflux and hiatal hernia maneuvers as for esophagram
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Double-contrast stomach | Supine + RPO/LPO | Mucosal relief, body and antrum |
| 2 | Upright stomach | Upright | Fundus, air-fluid level, GE junction |
| 3 | Full-column antrum/duodenum | Prone RAO | Compression of antrum and bulb |
| 4 | Duodenal bulb | RAO/supine | Ulcer, deformity |
| 5 | Duodenal C-loop / sweep | Supine + oblique | Mass, annular pancreas, malrotation |
| 6 | Esophagus screening | RAO/upright | Often included with UGI |
Key points
- Use water-soluble iodinated contrast for suspected perforation or postoperative leak; low-osmolar nonionic preferred if aspiration risk
- Glucagon contraindicated in pheochromocytoma and insulinoma; use cautiously in diabetics
- Double-contrast best for mucosal lesions; single-contrast/compression best for distensibility and motility
- Effervescent agent contraindicated if obstruction or perforation suspected
- Often combined with small bowel follow-through (UGI/SBFT)
References
• ACR Practice Parameter for the Performance of Esophagrams and Upper GI Examinations in Adults (gravitas.acr.org/PPTS)
• UT Southwestern Radiology Protocol: Upper GI Exam — Single or Double Contrast Barium
• Radiopaedia: Upper gastrointestinal series
• UT Southwestern Radiology Protocol: Upper GI Exam — Single or Double Contrast Barium
• Radiopaedia: Upper gastrointestinal series
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.