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Michael P. D'Alessandro, M.D.
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Barium taken by mouth or nasogastric tube.
With the patient supine, fluoroscope to observe the motion of the diaphragm.
Put the patient in the left lateral position, and give the patient barium, and take a lateral view of the esophagus.
Put the patient in the supine position, and give the patient barium, and take a supine view of the esophagus.
Put the patient in the right lateral position to empty the stomach and take a lateral view of the duodenal sweep.
When contrast is seen to enter the 3rd/4th part of duodenum, turn the patient supine and document the position of the duodenal jejunal junction with a spot film.
Move the patient from right to left lateral and back again to attempt to induce gastroesophagel reflux (Note if you are using a nasogastric tube for the exam, pull it above the gastroesophageal junction before checking for reflux.)
Aspirate the stomach at end of exam if you have a nasogastric tube down.
Views to Take:
AP view of the esophagus
Left lateral view of the esophagus
Right lateral view of the duodenal sweep AP view of the Ligament of Treitz Views of reflux if present
See References Chapter.
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