Evaluation of Upright Compression in Gastric X-ray Examination: Toward Standardized Implementation Criteria

Abstract

 Background and Aim: The upright compression technique in gastric radiography is an important method that complements double-contrast imaging. However, standardized image quality targets and procedural criteria have not been clearly defined. This study aimed to investigate the success rate and effectiveness of upright compression, and to clarify its utility and limitations as a screening modality.

 Methods: We evaluated 682 individuals who underwent gastric X-ray examinations at our institution in June 2024. The performance and success rates of the upright compression technique were assessed. Additionally, among 101 patients referred for further evaluation between April and December 2024, we examined the diagnostic contribution of compression imaging. Image adequacy was determined based on the degree of compression at the target site, image density, and barium coating. Statistical analyses included the chi-square test, Mann–Whitney U test, and logistic regression.

 Results: The implementation rate of upright compression was 81.8% (558/682), with a completion rate of 68.6% (468/682). Adequate compression images across all four target regions were obtained in 47.5% (324/682). Multivariate analysis identified independent predictors of successful compression: female sex (OR 3.80, 95% CI 2.41–6.07), lower BMI (per 5 kg/m² decrease: OR 1.92, 95% CI 1.29–2.91), non-transverse stomach (OR 2.06, 95% CI 1.14–3.76), and operator experience (per 5-year increase: OR 1.32, 95% CI 1.18–1.48). Among 45 evaluable cases in the follow-up cohort, compression was performed in 22, of which 10 (45.5%) demonstrated additional diagnostic value. Higher operator experience was significantly associated with improved effectiveness (median 30.0 vs. 7.0 years, p<0.01).

 Conclusion: The success of upright compression is influenced by patient sex, BMI, gastric morphology, and operator experience. Establishing standardized procedural criteria and strengthening training systems may enhance diagnostic accuracy in gastric screening.