Standardization of X-ray examination of the stomach and duodenum using the double contrast technique

Despite continuous advancements in endoscopic technologies, plain radiography has remained one of the principal methods of diagnostic imaging for gastric and duodenal disorders for decades. Indeed, the latest clinical guidelines for gastric cancer recommend fluoroscopy, assigning it an evidence level and strength of recommendation equivalent to upper endoscopy and computed tomography (CT) scans. This is because a multi-view barium swallow exam not only enables precise determination of tumor location and extent but also allows assessment of tumor spread to the esophagus and duodenum. Furthermore, previous studies have demonstrated that single-session double-contrast technique is particularly effective in detecting early (resectable) cancer stages.

At the same time, no universally standardized protocol currently exists for performing upper gastrointestinal series in patients with suspected gastric or duodenal cancer. Most authors provide only descriptive accounts of the methodological approaches employed, without specifying the exact number of images required to be obtained in standard views—let alone detailing the specific diagnostic information that should be obtained from each view. This lack of standardization undermines diagnostic efficacy, leads to an increased number of repeat examinations, and unnecessarily elevates radiation exposure for both patients and medical staff.

This article presents the authors’ extensive experience with double-contrast barium swallows to examine the stomach and duodenum, integrated with a comprehensive review of current scientific literature. A proposed standardized approach to conventional radiographic diagnosis of upper gastrointestinal disorders is outlined, including the implementation of single-session double-contrast technique as the second stage of the radiography.