The UGI with SBFT is a combined diagnostic procedure using fluoroscopic X-ray technology to visualize the upper digestive tract. Patients drink a liquid contrast agent, typically containing Barium, which coats the lining of the esophagus, stomach, and small intestine, making them visible on the X-ray screen. This examination allows doctors to evaluate the structure and function of these organs, looking for issues like inflammation, ulcers, or blockages. While the initial study of the esophagus and stomach is relatively quick, the total duration is highly variable because the follow-through portion depends entirely on the speed of a person’s digestion.
Preparing for the Upper GI and Small Bowel Follow-Through
A successful examination requires the stomach and upper small intestine to be empty, which means a strict period of fasting is necessary before arrival. Patients are typically instructed not to eat, drink, smoke, or chew gum after midnight the night before the procedure. This NPO (Nothing by Mouth) status, typically lasting around eight hours, ensures that residual food or liquid does not interfere with the contrast agent’s ability to coat the organ linings.
Patients should also inquire about specific medication restrictions, particularly those affecting stomach acid production or intestinal motility. Most regular medications may be taken with a small sip of water, but certain prescription or over-the-counter drugs may need to be temporarily stopped. On the day of the exam, it is necessary to remove all metal items, such as jewelry, eyeglasses, and clothing with zippers or snaps, as metal can obscure the X-ray images. Bringing comfortable clothing and a list of current medications helps streamline the check-in process before the examination begins.
Why the Procedure Duration Varies Significantly
The total time for the UGI with SBFT often ranges from two to four hours, but it can extend up to six hours or more. The first part, the Upper GI series, is generally quick, lasting only about 15 to 20 minutes. The subsequent Small Bowel Follow-Through introduces the variability in duration, as it involves passively waiting for the contrast to travel through the small intestine.
The speed at which the Barium contrast moves through the small intestine is known as small bowel transit time. A normal transit time can range between 30 and 120 minutes, but this depends on individual physiology. Factors like underlying conditions, such as diabetes or inflammatory bowel diseases, can slow down motility and extend the exam time. Aging has also been shown to be associated with a longer small bowel transit time.
The majority of the procedure duration is not active imaging time, but rather a waiting period between X-rays while the radiologist monitors the contrast progression. Images are taken periodically, often every 15 to 45 minutes, until the contrast agent reaches the cecum, which is the beginning of the large intestine. Because of this unpredictable waiting, patients are encouraged to bring a book or other distraction to help pass the time between imaging sessions.
The Step-by-Step Imaging Process
The procedure starts with the patient changing into a hospital gown and lying on a specialized fluoroscopy table. An initial X-ray is taken to ensure the abdomen is clear before the contrast agent is administered. The patient is then asked to drink the Barium contrast, a thick, chalky liquid that may be flavored to improve palatability.
As the patient drinks the contrast, the radiologist uses the fluoroscope to take real-time images of the Barium coating the esophagus and stomach. The patient will be asked to move into various positions, including standing upright and lying down, and the table may be tilted to help the contrast fully coat the stomach lining. In some cases, the patient may also swallow effervescent granules to create gas in the stomach, which helps to distend the organ and provide better visualization.
Once the UGI images are complete, the follow-through phase begins, and the patient may be asked to drink additional Barium. The patient will wait outside the fluoroscopy suite, and a technologist will take spot X-rays of the abdomen at set intervals to track the Barium’s journey through the small bowel. This sequential imaging continues until the contrast reaches the terminal ileum.
Post-Procedure Recovery and Instructions
Once the final X-ray image confirms the contrast has reached the large intestine, the patient is free to resume a normal diet and activity unless otherwise instructed. The most important post-procedure instruction is to promote the elimination of the Barium contrast. Drinking plenty of fluids, such as water and juices, is recommended for the next 24 to 48 hours to help flush the Barium out.
Patients should expect their stools to appear chalky white or gray for a few days following the exam, which is a normal result of the Barium passing through the colon. The contrast agent can sometimes cause temporary constipation, so increasing fluid intake and eating fiber-rich foods can help prevent this side effect. If constipation persists, a mild laxative may be recommended by a physician to aid in Barium clearance. The radiologist will interpret the images, and the results are typically sent to the referring physician within a few business days for discussion with the patient.