What is the role of upper GI imaging (UGI) in the diagnosis of pediatric pyloric stenosis?

Updated: Nov 13, 2018
  • Author: Sathyaseelan Subramaniam, MD, FAAP; Chief Editor: Kirsten A Bechtel, MD  more...
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Upper GI imaging (UGI) can help to confirm the diagnosis of infantile hypertrophic pyloric stenosis but is not routinely performed unless ultrasonography is nondiagnostic.

Although rarely performed now, the upper gastrointestinal study used to be the gold standard. The "shoulder" sign is a collection of barium in the dilated prepyloric antrum and may be seen in the infant with infantile hypertrophic pyloric stenosis. The "double track" sign (ie, 2 thin tracks of barium compressed between thickened pyloric mucosa), once thought to be pathognomonic of infantile hypertrophic pyloric stenosis, has recently been identified in multiple cases of sonographically confirmed pylorospasm and is shown in the image below.

Lateral view from an upper GI study demonstrates t Lateral view from an upper GI study demonstrates the double-track sign.

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