Time to Change Upper GI Default Orders -No Routine Scout

When I place an order for an upper GI, the computer prompt asks whether this should be with or without a scout film.  A recent retrospective study (S Abdullah et al. JPGN 2018; 67: 576-9) provides data indicating that the default setting should be without a scout xray.

After reviewing UGIs in 197 outpatients over a 2 year period, the authors found that

  • 97% found no significant findings in scout xray
  • 1.5% (n=3) had findings that were not addressed
  • 1% (n=2) had findings that required additional evaluation –both minor lung findings, later deemed insignificant
  • 0.5% (n=1) had a finding which resulted in a change in management –>a cleanout for excessive stool.  The report does not state whether this patient had a rectal exam which generally is more accurate with regards to the need for a cleanout

My take: This study provides convincing data that scout studies are usually unnecessary.  For inpatients, the main reason to order a scout xray would be if a patient had previous contrast that needs to be cleared prior to UGI.

Related blog post: Pre-PEG UGIs Often Unnecessary

Lake Maligne, near Jasper Canada

Pre-PEG UGIs -Low Yield If No Major Malformations or Cystic Fibrosis

From JPGN online and NASPGHAN twitter feed, bit.ly/19q99Y8 :

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0000000000000282

Abstract: “We studied the utility of a preoperative upper gastrointestinal series in children with and without major congenital anomalies undergoing gastrostomy tube (G-tube) placement. Of 1163 children evaluated, 743 had major anomalies and a total of 39 episodes of malrotation were found. All of the children with malrotation either had major congenital anomalies or cystic fibrosis. Our study suggests that an upper gastrointestinal series may be unnecessary prior to G-tube placement in children without other congenital anomalies or cystic fibrosis.”

Comment: while I agree with the conclusions of the abstract, it is worth noting that upper gastrointestinal series will pick up other abnormalities as well, including duodenal stenosis (which I have seen picked up on two separate occasions).