Small Bowel Barium X-ray (Follow-Through)

What it is

The small intestine is roughly twenty feet of loops packed into the middle of the abdomen, out of reach of a standard endoscope from either end. A follow-through gets at it the slow way. You drink barium, and instead of imaging once, the department takes an abdominal x-ray, waits, takes another, and keeps going as the contrast column works its way from the stomach down to the colon. Those serial and delayed images are what the code is describing.

Two things come out of it. One is shape: loops that are narrowed, dilated, displaced or stuck together, and the pattern of the lining folds. The other is motility — how fast or slow things move, which no single image can show. Toward the end the radiologist usually brings you to the fluoroscopy table to press on individual loops and separate them under live imaging, since in a plain film they overlap.

Why it is done

• To evaluate the small intestine for narrowing, inflammation or obstruction, in regions a scope from above or below does not reach
• To assess how waste moves through the bowel when transit itself is suspected to be the problem
• To look at anatomy after abdominal surgery, including adhesions and how a surgical connection is draining
• To follow known small bowel disease over time when a comparison with earlier studies is wanted

What to expect

Preparation is more involved than for a stomach study: dietary restriction the day before, sometimes a laxative, and fasting for several hours. The appointment is long — typically one to two hours, and considerably longer if your transit is slow, because the department cannot end the study until the barium reaches the colon. Most of that is waiting between films rather than being imaged, so bring something to do. Bring or plan for a meal afterward. Barium pales the stool for a day or two and drinking fluids afterward helps move it along.

Questions worth asking

• Because the length of the study depends on my own transit time, is this billed as a flat charge or can added imaging time increase it?
• If an upper GI study is done first in the same visit, are both billed, and is there a combined price?
• Does the prep — laxative, contrast to drink at home — come from the facility or from a pharmacy, and who pays for it?
• Is a CT or MR enterography an alternative my doctor would accept, and how does its out-of-pocket cost compare here?