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

Hari Kalagara; Rakesh V. Sondekoppam; Ali M. Ahmed; Krishna Venkata; Albert Pierce; Kaehler J. Roth; Rachel Mitchell; David Redden; Kondal R. Kyanam Kabir Baig; Shajan Peter

doi:10.1002/jum.16299

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

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

Hari Kalagara, Rakesh V. Sondekoppam, Ali M. Ahmed, Krishna Venkata, Albert Pierce, Kaehler J. Roth, Rachel Mitchell, David Redden, Kondal R. Kyanam Kabir Baig and Shajan Peter

Journal of ultrasound in medicine, Vol.42(11), pp.2643-2652

11/2023

DOI: 10.1002/jum.16299

PMID: 37401538

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Abstract

Objectives-Previous 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. Methods-We 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. Results-Qualitative 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. Conclusion-In 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.

aspiration

gastric ultrasonography

point of care ultrasound

upper gastrointestinal endoscopy

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Details

Title: Subtitle: Feasibility and Utility of Routine Point of Care Gastric Ultrasonography in Patients Undergoing Upper Gastrointestinal Endoscopy Procedures A Prospective Cohort Study
Creators: Hari Kalagara - Mayo Clinic in Florida
Rakesh V. Sondekoppam - University of Iowa, Anesthesia
Ali M. Ahmed - University of Alabama at Birmingham
Krishna Venkata - New England Baptist Hospital
Albert Pierce - University of Alabama at Birmingham
Kaehler J. Roth - University of Alabama at Birmingham
Rachel Mitchell - University of Alabama
David Redden - University of Alabama at Birmingham
Kondal R. Kyanam Kabir Baig - Univ Alabama Birmingham, Dept Gastroenterol, Birmingham, AL USA
Shajan Peter - University of Alabama at Birmingham
Resource Type: Journal article
Publication Details: Journal of ultrasound in medicine, Vol.42(11), pp.2643-2652
DOI: 10.1002/jum.16299
PMID: 37401538
NLM abbreviation: J Ultrasound Med
ISSN: 0278-4297
eISSN: 1550-9613
Publisher: Wiley
Number of pages: 10
Language: English
Electronic publication date: 07/04/2023
Date published: 11/2023
Academic Unit: Anesthesia
Record Identifier: 9984473233502771

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