Feasibility and Utility of Routine Point‐of‐Care Gastric Ultrasonography in Patients Undergoing Upper Gastrointestinal Endoscopy Procedures: A Prospective Cohort Study

Author:

Kalagara Hari1,Sondekoppam Rakesh V.2ORCID,Ahmed Ali M.3,Venkata Krishna4,Pierce Albert5,Roth Kaehler J.3,Mitchell Rachel3,Redden David6,Kyanam Kabir Baig Kondal R.3,Peter Shajan3

Affiliation:

1. Department of Anesthesiology and Perioperative Medicine Mayo Clinic Jacksonville Florida USA

2. Department of Anesthesia University of Iowa Hospitals and Clinics Iowa City Iowa USA

3. Department of Gastroenterology University of Alabama at Birmingham Birmingham Alabama USA

4. Baptist Medical Center South Montgomery Alabama USA

5. Department of Anesthesiology University of Alabama at Birmingham Birmingham Alabama USA

6. School of Public Health University of Alabama at Birmingham Birmingham Alabama USA

Abstract

ObjectivesPrevious studies have indicated that point‐of‐care ultrasonography (POCUS) of the gastric antrum can predict the adequacy of fasting before surgery and anesthesia. The aim of this study was to evaluate the utility of gastric POCUS in patients undergoing upper gastrointestinal (GI) endoscopy procedures.MethodsWe performed a single‐center cohort study in patients undergoing upper GI endoscopy. Consenting patient's gastric antrum was scanned before anesthetic care for endoscopy to determine the cross‐sectional area (CSA) and qualitatively determine safe and unsafe contents. Further, an estimate of residual gastric volume was determined using the formula and the nomogram methods. Subsequently, gastric secretions aspirated during endoscopy were quantified and further correlated with nomogram and formula‐based assessments. No patient required a change in the primary anesthetic plan except for using rapid sequence induction in those with unsafe contents on POCUS scans.ResultsQualitative ultrasound measurements consistently determined safe and unsafe gastric residual contents in 83 patients enrolled in the study. Unsafe contents were determined by qualitative scans in 4 out of 83 cases (5%) despite adequate fasting status. Quantitatively, only a moderate correlation was demonstrated between measured gastric volumes and nomogram (r = .40, 95% CI: 0.20, 0.57; P = .0002) or formula‐based (r = .38, 95% CI: 0.17, 0.55; P = .0004) determinations of residual gastric volumes.ConclusionIn daily clinical practice, qualitative POCUS determination of residual gastric content is a feasible and useful technique to identify patients at risk of aspiration before upper GI endoscopy procedures.

Publisher

Wiley

Subject

Radiology, Nuclear Medicine and imaging,Radiological and Ultrasound Technology

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