The upper gastrointestinal series at a crossroads.

Radiologic examination of the upper gastrointestinal tract, or the upper gastrointestinal series, is at a crossroads. As we approach the 21st century, it is possible to envision two very different scenarios for the future of this examination. The gradual but steady decline in the number of upper gastrointestinal studies done during the past decade could continue or even accelerate until this technique is no longer used in diagnostic radiology. Or, spurred by new concerns about cost and safety in a rapidly changing political and economic environment, the upper gastrointestinal series could undergo a dramatic resurgence, supplanting endoscopy as the primary diagnostic test in patients with symptoms in the upper gastrointestinal tract. Radiologists may ultimately have a pivotal role in determining the fate of the upper gastrointestinal series by their commitment or lack of commitment to perpetuating this form of examination. In this article, we consider the status of the upper gastrointestinal series in current medical practice and the challenges we face if it is to remain a useful diagnostic technique in the 21st century.