This chapter is concerned about related literature and studies which is related to the present study George F.

Longstreth states in his article How the Test is performed an upper GI and small bowel series is done in a doctor's office or hospital radiology department. You may be given an injection of a medicine that slows muscle movement in the small intestine. This lets the doctor see structures can be more easily on the x-rays. Before the x-rays are taken, you must drink 16 20 ounces of a milkshake-like drink. The drink contains a substance called barium, which shows up well on x-rays. An x-ray method called fluoroscopy tracks how the barium moves through your esophagus, stomach, and small intestine. Pictures are taken with you in a variety of positions. You may be sitting or standing. The test usually takes around 3 hours but can take as long as 6 hours to complete. A GI series may include this test or a barium enema. How to prepare for the Test You may have to change your diet for 2 or 3 days before the test. Usually, you cannot eat for a period of time before the test. Be sure to ask your health care provider if you need to change how you take any of your medicines. Often, you can continue taking the medicines you take by mouth. Never make any changes in your medicines without first talking to your health care provider. You will be asked to remove all jewelry on your neck, chest, or abdomen before the test. How the Test Will Feel The x-ray may cause mild bloating but usually causes no discomfort. The barium milkshake feels chalky as you drink it. Normal Results a normal result shows that the esophagus, stomach, and small intestine are normal in size, shape, and movement. Normal value ranges may vary depending on the lab doing the test. Talk to your doctor about the meaning of your specific test results. Some risks are low radiation exposure, which carries a very small risk of cancer. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women should usually not have this test.

Children are more sensitive to the risks of x-rays. Barium may cause constipation. Consult your health care provider if the barium has not passed through your system by 2 or 3 days after the exam. And there are some Considerations the upper GI series should be done after other x-ray procedures, because the barium that remains in the body may block details in other imaging tests.

Simeon Margolis states in his article about Upper Gastrointestinal Series its Purpose is To examine the upper GI tract in people with symptoms such as difficulty swallowing, regurgitation, burning or gnawing stomach pain, diarrhea, weight loss, vomiting of blood, and black, tarry stool to detect abnormalities of the upper GI tract, such as strictures ulcers, tumors, inflammatory conditions, esophageal diverticulitis, and hiatal hernia. He also make some article about risk and complication of upper Gastrointestinal and Small Bowel Series you receive a higher dose of radiation than during standard x-ray procedures. The x-ray may cause mild bloating but usually causes no discomfort. The barium may accumulate and block may cause discomfort in the intestines if it is not excreted within a few days. And gives some advice After the Upper Gastrointestinal and Small Bowel Series Drink plenty of fluids to help eliminate the barium. Your doctor may also give you a mild laxative to purge your body of the contrast agent. Your stool will be chalky and light-colored initially, but should return to normal color after 1 to 3 days. Inform your doctor if you experience abdominal fullness or pain after the procedure. If diatrizoate was used rather than barium, you may experience transient diarrhea. You may resume your normal diet, medications and activities.

The Center for Patient and Community Education in association with the staff and physicians at California Pacific Medical Center conduct studies about what can the patient expect during the gastrointestinal examination. It states that the patient may need an X-ray of your abdomen before the exam. Lie on an X-ray table. Then radiologist uses X-ray (fluoroscopy) to look at your internal organs. The table may be moved around and tilted into both horizontal and vertical positions during your exam. The patient may be asked to swallow a small amount of effervescent granules with an ounce of water at the beginning of your exam. This will release gas inside your stomach and can help the radiologist see the intestinal lining better. This gas may make you feel like you need to belch or burp. Try to avoid this for a short time at the beginning of the exam to get the best results. The patient will drink barium a thick, white, milkshake-like liquid. The taste may be unpleasant to you. You may experience mild abdominal fullness with this exam. Barium coats the inside of the esophagus, stomach, and duodenum, and makes them show up more clearly on X-rays. The radiologist can see the areas where the digestive system is blocked. Using a machine called a fluoroscope; the radiologist is also able to watch your digestive system work as the barium moves through it. During this exam, you will be asked to move around from side to side and from front to back. This allows the barium liquid to coat the entire lining of your stomach and allows the radiologist to take pictures from different angles. An upper GI series takes about 15 minutes to 1 hour to complete. X-rays of the small intestine may take up to 3 hours.

What the patient can expect after the exam. The patient may eat and drink normally after the exam. You should drink extra water or juice to help the barium pass through your intestine. The patient may drive her/his self home or return to work after this exam. For a day or two after the

exam, your bowel movements may be white or light in color as your body clears the barium from your system. For some patients, the barium may cause constipation. Call your doctor if you have concerns about constipation. And the patient may experience abdominal fullness with this examination

David M. Nolan states in his article that the upper GI Series is an endoscopy procedure that focuses on the bodys upper gastrointestinal tract, or GI tract. The human GI tract consists of many parts, starting from the mouth and ending at the anusbut the upper GI tract is considered to be a persons esophagus, stomach and duodenum If a patients upper GI tract is affected by ulcers, scars, hernias, diverticulitis or other obstructions, an upper GI series will be likely to detect these problems without having to resort to invasive surgery or other uncomfortable procedures. As with any medical screening, however, there is a chance that smaller abnormalities may be overlooked during the imaging procedure. The clarity and detail that can be achieved with x-ray is limited and, unfortunately, is usually not the method preferred by most endoscopists. In his journal he states what happens during an upper gastrointestinal series procedure. X-rays are taken at a radiology center or a doctors office with access to the proper equipment. The patient will stand in front of a special machine and drink a barium solution, a semi-thick liquid designed to make the lining of the upper GI tract show up as a bright, white color on the final image. A technology called fluoroscopy allows for viewing of the liquid as it moves downward and coats the patients throat, stomach and intestines. If the patient moves around which he or she may be asked to do the liquid will visibly move around on the x-ray monitor.

If a doctor has ordered a double contrast study, the patient may have to ingest special crystals designed to inflate the upper GI tract before more x-rays are performed. The crystals react with the barium solution around inside the patients body to produce gas that expands the area for a clearer view. He also states why the patients order an upper gastrointestinal series. Upper GI series are usually ordered in response to patients complaints of dysphagia, nausea or vomiting that persists for more than 2 weeks. The idea is that growths or other abnormalities in the throat, stomach and small intestine can keep a persons digestive system from processing food easily, either by blocking the food contents path through the GI tract or making food digestion a painful task. For example, an ulcer located in the esophagus may be irritated whenever a person eats, which may cause uncomfortable symptoms and worsen if the ulcer is left unattended. Patients who suffer from gastroesophageal reflux disease often undergo upper GI series, as well, so doctors can check for underlying medical causes.

Teresa G. Odle and Liana Watson states an article about efforts focus on better facilitating radiologist/radiologic technologist collaboration on care, feedback and quality improvement. In The Joint Commissions 2011 sentinel event alert regarding radiation risks in medical imaging, communication among clinicians, medical physicists, technologists and staff was cited as one of the contributing factors to avoidable radiation dosing.33 Traditionally, radiologic technologists have learned from radiologists about improving radiographic technique, and radiologists ultimately are responsible for mastery of technology and dedication to quality and safety in their practices.3 In todays digital imaging environment, collaboration between the technologist and radiologist does not occur as often as it did in the film-screen environment. This lack of

interaction has resulted in fewer opportunities for the technologist to learn from radiologists and talk about the quality of their images. Departments should adopt communication strategies and policies in the new digital environment to allow for and even encourage radiologist oversight, involvement and feedback on image technique, exposure and quality. Radiologic technologists usually have sole medical imaging department contact with patients and are the only professionals who might notice duplicate or inappropriate examinations before they occur. Technologists need radiologist input and cooperation to effectively communicate with patients and a departmental system in place in which they can report concerns regarding ordered examinations or technique questions and exposure issues. And they also create an article about Radiologic technologists are educationally prepared, clinically competent and certified in their respective modalities. When radiologic technologists are dedicated to lifelong learning and professional development, they maintain appropriate clinical competence for their respective Modalities. Although maintaining educational preparation and clinical competence is a personal responsibility and an important component of the technologists practice standards and ethics, the workplace culture should support technologists efforts. In addition, radiologic technologists should recognize that their professional self-worth and self-efficacy should be connected more closely to professional development than compensation. When medical imaging departments require that only technologists certified in, or working toward certification in, a respective modality perform procedures in their departments, they support professionalism. Managers can perform and present to administrators cost-benefit analyses of policies such as continuing education reimbursement to support continued competence and new or maintained certifications. Vendors, managers, radiologists, Administrators, radiologic technologists and other stakeholders can advocate for legislation to ensure registered radiologic technologists conduct examinations.

Med J Malaysia conducts a study about Common anxieties of patients undergoing oesophagogastro-duodenoscopy, colonoscopy and endoscopic retrograde cholangio-pancreatography. Majority of the anxious patients were afraid of pain. There was no difference between the "fearless" and "fearful" groups in terms of source of referral and inpatient/outpatient status. However for all 3 procedures, anxious patients were significantly younger by a mean of 10 years. Females, better educated and OGD patients undergoing the procedure for the first time were more anxious but this difference was not seen with the more complex colonoscopy and ERCP. The more sophisticated ERCP seemed to instill greater anxiety amongst Malay patients. Doctors were significantly more likely to explain the indication for OGD and colonoscopy than how it would be done. This discrepancy was not seen with ERCP where the endoscopists tend to adopt a more personal approach. Most patients prefer to be sedated.

A Holly M. Thompson and Robert A. Andrews state in their studies is about Usefulness of Upper Gastrointestinal Contrast Studies in Post-Laparoscopic Roux-en-Y Gastric Bypass Surgery. The laparoscopic Roux-en-Y gastric bypass is an effective intervention in treating class III obesity; however, new technologies come with the innate concern for detecting complications of which controversy exists regarding the usefulness of upper gastrointestinal studies. Due to the increasing number of bariatric patients and the associated cost of diagnostic studies, the authors felt it worthwhile to conduct a literature review to critically evaluate the debate surrounding the use of upper gastrointestinal studies. Their analysis supports the notion that clinical suspicion of the surgeon ought to be integrated into the decision management process prior to performing diagnostic tests. A prospective, randomized, controlled trial of routine versus selective upper gastrointestinal studies to detect leaks that evaluate the length of patient stay, hospital charges,

patient discomfort, and confidence of changes in clinical decisions is needed to objectively evaluate data of the safety and efficacy of upper gastrointestinal studies studies in postlaparoscopic Roux-en-Y bypass surgery.

Igor Jeroukhimov MD, Natan Poluksht MD, Nava Siegelmann-Danieli MD, Ron Lavy MD, Ilan Wassermann MD, Zvi Halpern MD, Ruth Gold-Deutch MD and Ariel Halevy MD conduct a study about The Role of Upper Gastrointestinal Swallow Study inPatients Undergoing Proximal or Total Gastrectomy

Background One of the ominous complications following proximal gastrectomy or total gastrectomy is a leak from the esophagogastric or esophagojejunal anastomosis. An upper gastrointestinal swallow study is traditionally performed to confirm the anastomotic patency and lack of any leak before oral feeding can be initiated.

Objectives To challenge the routine use of UGISs following proximal or total gastrectomy in order to check the integrityof the gastroesophageal or jejunoesophageal anastomosis.

Methods The charts of 99 patients who underwent PG or TG for malignant pathology were retrospectively reviewed. UGISs were performed on day 6 following surgery using a water-soluble material.

Results The UGISs were normal in 95 patients, with none displaying any complication related to the gastroesophageal or jejunoesophageal anastomosis. All four patients who experienced a leak from the anastomosis had an early stormy postoperative course.

Conclusions Routine use of an UGIS to detect a leak following PG or TG is not justified. UGIS should be performed whenever signs of abdominal sepsis develop following this type or surgery.

References http://www.asrt.org/docs/whitepapers/asrt13_patientsafetyql tywhitepaper.pdf http://www.ima.org.il/FilesUpload/IMAJ/0/40/20183.pdf http://bariatrictimes.com/usefulness-of-uppergastrointestinal-contrast-studies-in-post-laparoscopic-rouxen-y-gastric-bypass-surgery/

http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm http://www.healthcommunities.com/digestive-system-tests/upper-gi-and-small-bowel-series.shtml http://www.gastroenterology.com/procedures/upper-gi-series