patients preparation and procedure for

UGIS, esophagogram or barium swallow and

barium enema (including composition of
Barium sulfate)

Upper Gastrointestinal Series

(UGIS), Esophagogram or Barium
Swallow and Barium Enema

Barium Sulfate (BaSO4)

The most common positive or radiopaque contrast
medium used to visualize the gastrointestinal system
It is a powdered, chalklike substance mixed with
water before ingestion by the patient.
This particular compound, which is a salt of barium, is
relatively inert because of its extreme insolubility
in water and other aqueous solutions, such as acids.
Because it does not interact chemically with the body,
it rarely produces an allergic reaction. It
eventually is exelled rectally after the radiographic
procedure

Upper Gastrointestinal Series

Is a fluoroscopic and radiographic examination
of the upper gastrointestinal tract.
A radiocontrast agent is ingested or instilled
into the gastrointestinal tract that enhances
the visibility of the relevant parts of the
gastrointestinal tract by coating the inside wall
of the tract and appearing white on film.
The wall lining, size, shape, contour, and
patency are visible to the examiner

Contraindications to Barium Sulfate

If there is any chance that the mixture might
escape into the peritoneal cavity. If large amounts
of barium sulfate escape into the peritoneal cavity,
this can lead to intestinal infarcts or peritonitis.

Upper Gastrointestinal Series

Is a fluoroscopic and radiographic examination
of the upper gastrointestinal tract.
A radiocontrast agent is ingested or instilled
into the gastrointestinal tract that enhances
the visibility of the relevant parts of the
gastrointestinal tract by coating the inside wall
of the tract and appearing white on film.
The wall lining, size, shape, contour, and
patency are visible to the examiner

Upper Gastrointestinal Series

When there is concern about leakage of x-ray contrast through
a perforation, Gastrografin (a water-soluble contrast) is used.
Lower Esophagus- examined for position, patency, and filling
defects. (tumors, scarring, varices)
Stomach- gastric wall is examined for benign and malignant
ulcerations, filling defects (most often in cancer), and anatomic
abnormalities (e.g hiatal hernia).
Gastroesophageal reflux of Barium- patient is placed in a flat or
a head-down position.
As contrast leaves the stomach, patency of the pyloric channel
and the duodenum is evaluated. Benign peptic ulcerationsmost common pathologic condition

Barium Swallow
is a radiographic (X-ray) examination of the
upper gastrointestinal (GI) tract, specifically
the pharynx (back of mouth and throat) and
the esophagus (a hollow tube of muscle
extending from below the tongue to the
stomach).

Indications
high or lowdysphagia
gastro-oesophageal
reflux disease (GORD/GERD)
assessment of ahiatus hernia
generalised epigastric pain
globus hystericus
persistent vomiting
assessment of fistula
inability to pass the endoscope during UGIE

Contraindications
Water-soluble contrast agents should be used instead
of barium in the following cases:
suspected perforation
Patients with evidence of bowel obstruction
suspected tracheo-oesophageal or bronchooesophageal fistula
post-operative assessment for leak
Caution should be exercised when using water-soluble
contrast agents in patients with a risk for aspiration.
Aspiration of high-osmolarity water-soluble contrast
agents has been associated with massive pulmonary
oedema and subsequent death. A low osmolarity agent
such as Omnipaque may be used in this setting.

Potential complications
Barium-induced fecal impaction

Procedure and Patient Care

BEFORE
Explain the procedure to the patient
Instruct patient not to take anything by
mouth for at least 8 hours before testing.
Assess the patients ability to swallow. If the
patient tends to aspirate, inform the
radiologist.

Procedure and Patient Care

DURING
1. The fasting patient is asked to swallow the contrast
medium.
2. As the patient drinks the contrast through a straw, the
x-ray table is tilted to the near-erect position.
3. The patient is asked to roll into various positions so that
the entire esophagus can be adequately visualized.
4. With fluoroscopy, the radiologist follows the barium
column through the entire esophagus.
**15-20 minutes

Procedure and Patient Care

AFTER
Inform the patient the need to evacuate all
the barium. Cathartics are recommended.
Initially stools are white but should return to
a normal color with complete evacuation

Abnormal findings

Total or partial esophageal obstruction

Cancer
Scarred strictures
Lower esophageal rings
Peptic esophageal ulcers
Varices
Peptoc or corrosive esophagitis
Achalasia
Esophageal motility disorders
Diverticula
Chalasia
Extrinsic compression from extraesophageal tumors,
cardiomegaly, or aortic aneurysm.

Barium Enema
Consists of a series of x-rays visualizing
the colon.
Used to demonstrate the presence and
location of polyps, tumors, and diverticula.
Anatomic abnormalities also can be
detected.
Therapeutically, the BE may be used to
reduce nonstrangulated ileocolic
intussusception in children.

Contraindications
Patients suspected of a perforation of colon
Patients who are unable to cooperate
Patients with Megacolon

Potential Complications
Colonic perforation, especially when the colon is
weakened by inflammation, tumor or infection.
Barium fecal impaction

Interfering factors
Barium within the abdomen from previous
barium tests
Significant residual stool within the colon
precludes adequate visualization of the
entire bowel wall. Stool may be confused
with polyps.
Spasm of the colon can mimic the
radiographic signs of a cancer.

Procedure and Patient Care

BEFORE
Explain procedure to patient.
Assist with bowel preparations.
Day before examination
Give clear liquids for lunch and supper
Instruct to drink one glass of water or clear fluid every 8
to 10 hours
Administer cathartic or X-Prep at 2pm
Administer three 5 mg bisacidyl (dulcolax) tablets at 7pm
Keep patient NPO after midnight the day of the test

Procedure and Patient Care

Day of Examination
Keep patient NPO
Administer bisacodyl suppository at 6 am
and or a cleansing enema.
Note that special prep will be ordered for
patients with an ileostomy or colostomy.
Determine whether the bowel is adequately
cleansed.

Procedure and Patient Care

DURING
test begins with the placement of a rectal balloon catheter.
The balloon on the catheter is inflated tightly against the
anal sphincter to hold the barium within the colon.
The patient is asked to roll into the lateral, supine, and
prone positions.
The barium is dripped into the rectum by gravity.
The barium flow is monitored fluoroscopically.
The colon is thoroughly examined as the barium flow
progresses through the large colon and into the terminal
ileum.

Procedure and Patient Care

The barium is drained out.
If an air-contrast BE has been ordered, air is
insufflated into the large bowel.
The patient is asked to expel the barium,
and a post-evacuation x-ray image is taken
**45 minutes

Procedure and Patient Care

AFTER
Ensure that the patient defecates as much
barium as possible.
Encourage ingestion of fluids to avoid
dehydration caused by cathartics
Encourage rest after the procedure
Be aware of dehydration and electrolyte
abnormalities
Inform patient bowel movements will be white.

Abnormal Findings

Malignant tumor
Polyps
Diverticula
Inflammatory bowel diseases
Colonic stenosis
Perforated colon
Colonic fistula
Appendicitis
Extrinsic compression of the colon from extracolonic tumors
Malrotation of the gut
Colon volvulus
Intususception
Hernia