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Gastrointestinal Fluoroscopy

Though plain film radiography and CT are crucial diagnostic tools, they are limited by their ability to only capture images at one point in time. Fluoroscopy allows for dynamic and functional imaging, which is often invaluable in evaluating gastrointestinal pathologies.

  • Esophagram

    • The exact technique varies by radiologist and the study indication; generally, the patient swallows several contrast boluses as images are obtained of the pharynx, esophagus, and proximal stomach
    • Potentially much more sensitive than CT for the evaluation of perforation or fistula; however, in the emergent setting a CT chest/abdomen with an appropriately timed water-soluble oral contrast bolus may suffice
    • Inpatient exams for indications other than perforation are nearly always appropriately deferred to the outpatient setting

  • Upper GI

    • Imaging is obtained of the esophagus, stomach, and duodenum to the ligament of Treitz; no imaging of the jejunum or ileum is obtained
    • Often utilized for evaluation of esophageal hernias, post-operative complications, and gastric outlet obstruction

  • Small Bowel Follow Through

    • Essentially this is an Upper GI with additional serial images obtained to follow the contrast bolus until it reaches the cecum
    • If obstruction is of concern, a version of this exam can be performed (Non-Fluoro SBFT) on the floor; after a period of gastric decompression via NGT the patient is instructed to drink 150-300 mL of water-soluble contrast while several serial abdominal radiographs are obtained until contrast reaches the cecum or the exam is aborted

  • Contrast Enemas

    • Often called barium enema, which is a misnomer since barium is rarely used
    • Typically performed to evaluate suitability of distal bowel for ostomy reversal

  • Dobhoff Tube Placement

    • A common misconception is that there is direct visualization of the tube during the placement; in the fluoroscopy suite the radiologists are placing tubes in the exact same manner as on the floor
    • The benefit is purely logistical since radiologists can take an immediate spot fluoro image to evaluate the tube position rather than needing to wait for an image to be obtained and interpreted
    • There is no safety benefit and a request for fluoro guided placement should not be considered to be above routine priority