Imaging

Peptic Stricture

Preliminary Diagnosis: Peptic Stricture

I. What imaging technique is first-line for this diagnosis?

  • Double contrast upper gastrointestinal barium study

II. Describe the advantages and disadvantages of this technique for diagnosis of peptic stricture.

Advantages

  • Relatively quick and inexpensive imaging modality

  • Highly portable

  • More sensitive and specific in defining and detailing the underlying mucosa than single contrast studies

  • Highly sensitive and specific in characterizing underlying ulcers, craters, edema, or strictures

Disadvantages

  • Exposes patients to a significant amount of ionizing radiation

  • Highly operator dependent

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • CT of the abdomen and pelvis with IV and oral contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of peptic stricture.

CT of the abdomen and pelvis with IV and oral contrast

Advantages

  • Less operator dependent than double contrast barium studies

  • Offers much better visualization and characterization of the surrounding anatomical structures

Disadvantages

  • Offers less exquisite detail of the underlying intestinal mucosa

  • Less sensitive and specific in diagnosing a peptic stricture

  • Less portable than double contrast barium studies

VI. What are the contraindications for the alternative imaging techniques?

CT of the abdomen and pelvis with IV and oral contrast

  • May be contraindicated in pregnant patients

  • Relative contraindication in patients with renal failure and contrast allergy

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