The logic behind performing screening UGI studies before g tube placement has always escaped me. I understand the rationale behind screening for malro before a Nissen +/- g tube, since reflux could be due to some level of partial obstruction from malro; but why UGI's for g tubes without reflux? It certainly is not a useful test to screen for reflux. We definitely do not need to know where the stomach is before place a g tube, so why the radiation exposure?
A study by Abbas et al noted that the incidence of unexpected malro identified by screening UGI's performed for patients undergoing a routine gastrostomy tube placement is 1.7% (5/229).
Even if one accepts that avoiding a potential catastrophic event in 2 patients is worth the risk of radiation (300 cGy/UGI study) to the other 98, this logic should be applicable to all preop patients (since the need for a g tube does not necessarily select out a population at higher risk of malrotation).
So why do we not screen all preop patients with UGI's?(not suggesting that we should, for the trolls out there!).
Some more data to help support what we do (or don't do).
Sani--I used to get an UGI for the same reasons you mentioned but with the same reservations. Now, I and my partners only get an UGI if there is a specific reason, like reflux symptoms that bring up the possible malro issue or to check gastric capacity (to make sure an intraluminal balloon won't take too much space). Sometimes a plain film alone can also get you all the information that you need.
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