The double-contrast upper GI series makes medical and economic sense as a cost-effective alternative to endoscopy for evaluating patients with dyspepsia or other upper GI symptoms who fail to respond to an empiric trial of medical therapy. These studies are capable of detecting most clinically significant disease in the upper GI tract. Furthermore, data indicate that double-contrast studies can achieve a high sensitivity in the diagnosis of malignant lesions without exposing an inordinate number of patients to unnecessary endoscopy. Thus, as we approach the twenty-first century, the upper GI series continues to be a valuable diagnostic test in modern medical practice.