A new and simple approach to air-contrast studies of the stomach and duodenum.

Abstract

Since the early days of roentgenology many methods of producing double-contrast studies of the stomach and duodenum have been described. These procedures have included the use of effervescent powders and carbonated beverages, the conscious swallowing of air, insufflation and inflation of the stomach by means of inserted tubes, and utilization of the air physiologically present in the stomach. Although the double-contrast examination has proved its value and become routine, currently used technics still have certain limitations and disadvantages. The “Straw Technic” We would like to present the “straw technic” as a new and extremely simple approach to air-contrast studies. This procedure is easily executed and requires no chemicals, no time-consuming instrumentation, no awkward equipment. Technically it affords excellent films. For the “straw technic” the examiner needs only an ordinary drinking straw, either paper or plastic, which has been punctured midway to produce a small perforation. By means of this device one obtains simultaneous aspiration of barium mixture and air when the opaque medium is sipped. The size of the perforation in the straw is an important factor. It must be determined experimentally and depends upon the dilution of the medium employed. The hole should be very small to allow the formation of only tiny air bubbles within the contrast material. This will insure an easily swallowed bolus containing both air and barium. A larger perforation requires excessive effort on the part of the patient, and the end-results are less favorable, as a smaller amount of air actually is swallowed. We have found a through-and-through perforation of the straw made with a very small sewing needle suitable. Puncture of one wall made perpendicularly with a medium-sized safety pin is also adequate with our standard barium medium. Once the size of the perforation has been determined, a supply of straws can be prepared and kept available. It is well to advise a patient that he is drinking through an artificially perforated straw to insure his co-operation. Usually sufficient air will have entered the stomach when the patient in the upright position has ingested 2 to 3 ounces of the medium. This is easily controlled fluoroscopically. In those cases in which a patient is known to have a questionable lesion in the antrum or body of the stomach, the examination is begun in the horizontal left anterior oblique position. After 2 ounces of barium suspension have been sipped through the straw, the patient immediately assumes the right anterior oblique position for demonstration of the lesion by double contrast. In most cases no contrast material will have entered the duodenum and there will be no superimposition of small-bowel shadows. By turning the patient into different obliquities and changing the tilt of the table, it is possible to demonstrate even very minute lesions of the posterior wall (Fig. 1).