How I Do It

T HE development of routine doublecontrast techniques for examining the upper gastrointestinal (GI) tract has dramatically improved our ability to diagnose a variety of inflammatory and neoplastic diseases in the esophagus, stomach, and duodenum. Despite increasing acceptance of this technique, many radiologists still use conventional single-contrast radiography as the primary modality for examining the upper GI tract. In a recent survey, more than 50% of the responding radiologists at major academic institutions indicated that they did not perform double-contrast upper GI studies on a routine basis (1). In many cases, doublecontrast techniques are avoided because of lack of experience or training in the technical aspects of performing or interpreting these studies. The issue of singleversus doublecontrast technique has recently been overshadowed by another, more ominous development in the practice of GI radiology. Data indicate that there has been a gradual but steady decline in the total number of upper GI fluoroscopic examinations p;rformed during the past decade (2,3). This trend can be attributed partly to the increased use of cross-sectional imaging modalities, such as computed tomography or ultrasound, to evaluate GI problems. The greater availability of effective hista-