Efficacy of Bedside Upper Gastrointestinal Technique in NICU Infants

Objective To review our experience with the bedside upper GI technique in determining the duodenojejunal junction (DJJ) position in neonatal intensive care (NICU) infants with suspected midgut volvulus. Materials and methods Bedside UGI series in NICU infants less than 6 months old between 2014–2024 were identified using the hospital database and independently reviewed by two pediatric radiologists blinded to the original interpretation. Studies were evaluated for DJJ location and categorized as normal, abnormal or nondiagnostic. Nondiagnostic studies were investigated to determine the reason for failure to identify the DJJ. Clinical and surgical outcomes were recorded. Results 163 bedside UGI studies were reviewed. Most (91.4%) were normal. Four (2.5%) were abnormal, one with midgut volvulus confirmed at surgery. Ten (6.1%) were nondiagnostic due to: contrast filled loops obscuring the DJJ (4), insufficient duodenal opacification (2), organoaxial gastric positioning (2), patient rotation (1) and enteric tube malposition (1). Four nondiagnostic cases had immediate fluoroscopic UGI series using Barium. One had midgut volvulus confirmed at surgery. The remaining 6 nondiagnostic studies were originally interpreted as normal and therefore had no further imaging. There were no false positive or negative exams. Conclusion In NICU patients in whom malrotation with volvulus is suspected, bedside UGI is a reliable tool for assessing the DJJ position, as it eliminates the need to transport the infant. Any diagnostic uncertainty due to insufficient contrast, obscuration of the DJJ or patient rotation should prompt immediate follow-up UGI series with barium in the fluoroscopy suite to avoid a missed diagnosis.