Gastrografin Challenge Protocol, SBO, Dose, Test, Timing, ICD-10 & CPT Code

Gastrografin Challenge Protocol

The Gastrografin challenge is a diagnostic test that determines the likelihood of effective non-surgical treatment for patients with adhesive small bowel obstruction (ASBO). In order to track the contrast agent's passage through the small intestine, serial X-rays must be taken after it is administered orally (Gastrografin).

Gastrografin Challenge SBO

The gastrografin challenge, which is also referred to as the water-soluble contrast challenge, is a diagnostic and therapeutic test that is utilized for the purpose of evaluating the presence of adhesions that may be the cause of small intestinal obstruction (SBO). Using a nasogastric tube, a contrast agent—typically gastrografin—is administered, and over the course of the following 24 hours, successive abdominal X-rays are taken to monitor the agent's passage through the small intestine.

Gastrografin Challenge Indications

• Individuals who exhibit clinical symptoms and plain X-ray findings suggestive of ASBO.
• individuals who are not in critical condition and show no symptoms of intestinal perforation or ischemia.

Gastrografin Challenge Contraindications

• Pregnancy
• Known or suspected gastrointestinal perforation
• Severe vomiting or nasogastric tube intolerance
• Contrast media allergy
• Recent abdominal surgery

Gastrografin Challenge Protocol

• Nasogastric (NG) tube placement: A low suction NG tube is inserted and left in position for a minimum of 2 hours in order to decompress the stomach and proximal small intestine.
• Gastrografin administration: Using the NG tube, 100 mL of undiluted gastrografin is administered.
• NG tube clamping: After administering gastrografin, the NG tube is clamped for two hours.
• Serial X-rays: To monitor the passage of the contrast material through the small intestine, abdominal X-rays are taken at regular intervals (usually every 2, 4, 8, and 24 hours).

Gastrografin Challenge Interpretation

• Success: The presence of Gastrografin in the colon within a 24-hour period indicates that conservative management, including nasogastric tube decompression, intravenous fluids, and pain control, is likely to be effective in resolving the obstruction.
• Failure: It indicates that the obstruction is unlikely to clear up with conservative treatment and may require surgery if Gastrografin is not detected in the colon within 24 hours.

Gastrografin Challenge Dose

• 100 mL of undiluted Gastrografin.

Gastrografin Challenge Test

• Serial abdominal X-rays.

Gastrografin Challenge Timing

• NG tube decompression for 2 hours before Gastrografin administration.
• NG tube clamping for 2 hours after Gastrografin administration.
• Serial X-rays at 2, 4, 8, and 24 hours.

Gastrografin Challenge ICD-10 Code

ICD-10 codes related to diagnostic imaging of the digestive tract and screening for upper gastrointestinal disorder may be relevant to the Gastrografin challenge protocol. These include:

R93.3 - Abnormal findings on diagnostic imaging of other parts of the digestive tract.

Gastrografin Challenge CPT Code

CPT code 74270 is used for diagnostic radiology procedures of the gastrointestinal tract, which includes the evaluation of the colon after instilling a contrast agent such as barium.