• Esophagus, Stomach and Duodenum (ESD)

    Preparation: One hour

    Anatomy involved: Esophagus, stomach, and duodenum

    Performed by: Radiologist (physician), technologist, fluoroscopy assistant

    Preparation: No food, liquids or oral medications from 12 midnight to time of exam. Patients with ostomies having GI studies should bring extra bags.



    Stomach and Duodenum An esophagus, stomach and duodenum (ESD) exam is a fluoroscopic and X-ray evaluation of the first part of your digestive system, including the esophagus (swallowing structure), stomach, and duodenum (first portion of the small bowel). To better delineate these structures during fluoroscopy, a contrast medium or "dye" called barium is ingested which outlines and coats the walls of the digestive system. A second substance called bicarbonate powder is ingested in addition to produce gas, which also serves to aid in visualization of these structures during the exam.


    Before and During the Exam

    Before the actual test begins, a technologist will take one or two X-rays of your abdomen – a "before barium" picture. After these films are checked, a fluoroscopy assistant will bring you into the room with a special scanning X-ray unit called a fluoroscope. A fluoroscope is a device equipped with a fluorescent screen on which the internal structures of an optically opaque object, such as the human body, may be continuously viewed as shadow-like images formed by the transmission of X-rays through the object. Using fluoroscopy, the radiologist is able to view the organs being examined in real time, and take X-rays of particular areas of interest. The fluoroscopy assistant will briefly explain the exam and then notify the radiologist that you are ready for your test.

    The radiologist will then review your record to determine the best method of examination. In certain cases, the radiologist will administer glucagon intravenously just before the beginning of the exam. Glucagon is a normal product in the body secreted by the pancreas. It slows digestive movements for approximately five to 10 minutes, enabling the radiologist to better view the stomach without motion. The end result is better detail with slightly less radiation. In rare cases, glucagon may cause mild momentary cramping.

    While you are in a standing position, the radiologist will give you two cups, one containing bicarbonate powder and the other, barium. The liquid barium has somewhat of a chalky taste masked by added flavors such as strawberry. The powder is ingested first, quickly, followed by the barium. The gas producing powder will make you feel the need to belch. However, you should hold the gas in (by swallowing your saliva if necessary) as its presence in the stomach greatly enhances the detail of the radiographic images.

    You will then be placed in a reclining position on the X-ray table. The radiologist will have you move in different positions to manipulate the gas and barium so that optimal images of the anatomy being viewed can be obtained. The radiologist may apply mild focal pressure to parts of your abdomen during the exam to better visualize certain structures.


    After the Exam

    When the radiologist is finished, the technologist may take one or two more final X-rays. The examination will then be complete and will be interpreted by the radiologist. You may then take your chart and proceed to your next appointment.

    After the exam, you can resume a regular diet and take orally administered medications unless told otherwise by your doctor. The barium may color stools gray or white for approximately 48 hours after the procedure. You are encouraged to drink additional water during this time to help pass the barium. In rare instances, the barium may cause temporary constipation, which can usually be treated well with an over-the-counter laxative.

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