Fluoroscopy Upper GI Series Quick Reference Guide for Physicians

The Upper Gastrointestinal Exam or Upper GI Series looks at the upper and middle sections of the GI tract under fluoroscopy. It consists of a series of x-ray images of the esophagus, stomach and the upper gastrointestinal tract. The most common use for this test is to look for signs of ulcers, acid reflux disease, unexplained uncontrollable vomiting or blood in the stools, hematochezia or positive fecal blood.

Counterindications

Bowel or esophageal perforation, bowel obstruction or severe constipation, pregnancy.

How should my patient prepare?

Light evening meal. Nothing by mouth after bedtime the day before the exam.

CPT Codes

• 74246 UGI with Air (most common)
• 74249 UGI with Air and Small Bowel
• 74240 UGI no Air
• 74245 UGI no Air with Small Bowel

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General Information

What is an upper GI series?

A upper GI series is an x-ray examination of the distal esophagus, stomach & duodenum, using fluoroscopy and an orally ingested contrast material called barium.

Fluoroscopy makes it possible to see internal organs in motion. When coated with barium, the radiologist is able to view and assess the anatomy and function of the upper gi tract. In addition to drinking barium, some patients are also given baking-soda crystals (similar to Alka-Seltzer) to further improve the images. This procedure is called an air-contrast or double-contrast upper GI.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant.

Your patient may be asked to remove some or all of your clothes and to wear a gown during the exam. Your patient may also be asked to remove jewelry, dentures, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

How is the procedure performed?

As the patient drinks the liquid barium, which resembles a light-colored milkshake, the radiologist will watch the barium pass through the patient's digestive tract on a fluoroscope, a device that projects radiographic images in a movie-like sequence onto a monitor. The exam table will be positioned at different angles and the patient's abdomen may be compressed to help spread the barium. Once the GI tract is adequately coated with the barium, still x-ray images will be taken and stored for further review.

The patient will be asked to hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. For a double-contrast upper GI series, the patient will swallow baking-soda crystals that create gas in the stomach while additional xrays are taken.

When the examination is complete, your patient will be asked to wait until the radiologist determines that all the necessary images have been obtained.

This exam is usually completed within 20 minutes.

What will my patient experience during and after the procedure?

After the examination, your can resume a regular diet and take orally administered medications.

The barium may color your patient’s stools gray or white for 48 to 72 hours after the procedure. Sometimes the barium can cause temporary constipation, which is usually treated by an over-thecounter laxative. Drinking large quantities of fluids for several days following the test can also help. If your patient is unable to have a bowel movement or if his/her bowel habits undergo any significant changes following the exam, the patient should call you.