Ultrasonographic assessment of preoperative gastric volume in patients with dyspepsia: a prospective observational study

Abstract

Background Patients undergoing gastroenteroscopy during sedation are prone to aspiration, and most patients with dyspepsia have delayed gastric emptying. This study aimed to investigate the feasibility of measuring the gastric antrum cross-sectional area (CSA) to supply a novel clinical diagnostic reference value in patients with dyspepsia. Methods Patients with dyspepsia undergoing elective gastroscopy were included. The Perlas qualitative 0–2 grading scale score was determined before the operation. The anteroposterior diameter (D1) and craniocaudal diameter (D2) between gastric antrum serosal surfaces were measured perpendicular to each other in the supine and right lateral decubitus (RLD) positions. CSA values in the supine position and RLD position were determined. Gastric contents were endoscopically suctioned with the volumes measured and noted as actual gastric volume. Multiple regression analysis was used to fit a mathematical model for estimating the gastric volume. Receiver operating characteristic (ROC) curves were constructed to determine the accuracy of RLD CSA to detect gastric volumes of > 0.8 ml/kg. Results A total of 117 patients were enrolled and divided into a functional dyspepsia (FD) group and an organic dyspepsia group according to gastroscopy findings. For a gastric volume of > 0.8 ml/kg, cut-off values for FD and organic dyspepsia were 6.7 cm2 and 10.0 cm2, respectively. Two new modified mathematical models were derived to predict an estimated gastric volume for FD and organic dyspepsia: volume = 3.93 × RLD CSA - 0.47 × age; and volume = 6.15 × RLD CSA - 0.61 × age. Conclusion We used the cut-off value of the antral area for the fast diagnosis of gastric volumes in patients with dyspepsia, which may assist clinicians in identifying patients at risk of aspiration. Trial registration www.chictr.org.cn (CHICTR-DDD-17010871); registered 15 March 2017.

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“…In recent studies, the effectiveness of imaging complete cross-sections via ultrasonography has been shown to be reduced when the stomach is filled with solid food [ 11 ]. While high correlation coefficients have been noted in various mathematical models to predict gastric volumes, with adjusted R 2 values ranging from 0.60 to 0.73, these models have been found to be less reliable in cases of organic dyspepsia and gastroparesis [ 49 ]. This has spurred the development of computational simulations and modeling of gastric flow, offering valuable insights through integrative and quantitative in silico studies that may be challenging to perform experimentally [ 50 , 51 , 52 ].…”

Role of gastric ultrasound to guide enteral nutrition in the critically ill

“…The cut-off value for patients with organic dyspepsia to predict gastric volume >0.8 ml/kg was 10.0 cm 2 , with a sensitivity of 92. 7% and a specificity of 82.4% [10]. However, it does not access gastrointestinal dynamics.…”

“…The pretest probability of 50% a sensitivity of 100% and a specificity of 97.5% with a positive predictive value of 97.6% and a negative predictive value of 100%. Tan et al [10] with 117 patients, reported for a gastric volume of >0.8 ml/kg, cut-off values for functional dyspepsia and organic dyspepsia were 6.7 cm 2 and 10.0 cm 2 , respectively. The cut-off value for patients with FD to predict gastric volume of >0.8 ml/kg was 6.7 cm 2 , with a sensitivity of 100% and a specificity of 48.7%.…”