Method

1. While the patient is lying supine on the x-ray table, slowly inject 0.2 mg of glucagon intravenously. (When you are just beginning to learn the procedure and are slow, consider using 0.3 mg.) 
   
   
2. Raise the x-ray table to the upright position. The patient stands on the footrest with his back against the table top. (If patient cannot stand, elevate head of table 30-45 degrees.) Quickly scan the abdomen with the fluoroscope to check for contraindications to the study: free air beneath diaphragm or residual barium from a previous exam. 
   


3. Immediately before using the chilled soda siphon, shake it vigorously and dispense "bubbly barium" into a 10 oz cup. Only fill the cup 1/2 full. Have the patient hold the cup of barium in the left hand. (Have the technologist hold the cup if patient is disabled.) 
   
   
4. Rotate the patient into a left posterior oblique (LPO) position (to rotate the spine away from overlapping with the esophagus).
   
   
   1. Ask the patient to drink 1/2 cup of "bubbly barium" quickly and tell him not to belch. Scan the length of esophagus while the patient swallows. Obtain two double-contrast spot images - one of the upper and one of the lower esophagus (including the gastric cardia) during maximal gas distention after all gas bubbles have disappeared. Collimate the fluoroscopic image side-to-side before taking the esophageal spot images.

2. Then, take the empty cup from the patient and refill it 1/2 full with "bubbly barium". Repeat the same spot images in the right posterior oblique (RPO) position while the patient holds the cup in his right hand and drinks an additional 1/2 cup of "bubbly barium". Do not have the patient stop breathing or swallowing while making the exposures.