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Ultrasound assessment of gastric residual volume in patients over 60 years of age undergoing gastroscopy under sedation: a prospective cohort study

Évaluation échographique du volume gastrique résiduel chez la patientèle de plus de 60 ans bénéficiant d’une gastroscopie sous sédation : une étude de cohorte prospective

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Abstract

Background

We aimed to assess the accuracy of ultrasonographic measurement of the antral cross-sectional area (CSA) in the preprocedural evaluation of gastric contents and volume in fasted patients > 60 yr of age scheduled for gastroscopy under sedation.

Methods

We included n = 81 patients > 60 yr of age and n = 79 younger controls scheduled to undergo elective gastroscopy in a prospective cohort study. A gastric ultrasound examination was performed to measure the antral CSA in both semisitting and right lateral decubitus (RLD) positions. Afterward, patients were graded using the Perlas qualitative grading scale. The actual gastric volume was endoscopically suctioned. Full stomach was defined as gastric volume > 1.5 mL·kg–1 and/or the presence of solid particles. We constructed receiver operating characteristic curves to determine the accuracy of ultrasonographic measurement of RLD CSA to detect a gastric volume > 1.5 mL·kg–1 and calculated the diagnostic test attributes of RLD CSA for the identification of a gastric volume > 1.5 mL·kg–1

Results

The incidence of full stomach was 8/81 (9.8%) in patients > 60 yr of age and 1/79 (1.2%) in young patients (risk difference, 8.6%; 95% CI, 1.3 to 15.8; P = 0.03). The cut-off value of RLD CSA was 10.4 cm2 for the detection of gastric volume > 1.5 mL·kg–1 in patients > 60 yr of age, with a sensitivity of 75%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98.6%.

Conclusion

Patients > 60 yr of age scheduled for gastroscopy under sedation had a higher incidence of a full stomach detected with ultrasound compared with a younger cohort, which is potentially associated with a higher aspiration risk. We calculated a cut-off value of RLD CSA for detecting gastric volume in patients > 60 yr of age of approximately 10 cm2, which may help to quickly assess patients at risk of aspiration.

Trial registration

www.chictr.org.cn (ChiCTR2100048994); registered 19 July 2021.

Résumé

Contexte

Notre objectif était d’évaluer la précision de la mesure échographique de la section transversale antrale (CSA) dans l’évaluation préprocédurale du contenu et du volume gastriques chez les patient·es à jeun > 60 ans devant bénéficier d’une gastroscopie sous sédation.

Méthode

Nous avons inclus n = 81 patient·es > 60 ans et n = 79 patient·es témoins plus jeunes devant bénéficier d’une gastroscopie non urgente dans une étude de cohorte prospective. Une échographie gastrique a été réalisée pour mesurer la CSA antrale en position semi-assise et en décubitus latéral droit (DLD). Par la suite, la patientèle a été classée à l’aide de l’échelle de classement qualitatif de Perlas. Le volume gastrique réel était aspiré par endoscopie. Un estomac plein a été défini comme un volume gastrique > 1,5 mL·kg–1 et/ou la présence de particules solides. Nous avons construit des courbes de la fonction d’efficacité du récepteur (courbes ROC) afin de déterminer la précision de la mesure échographique de la CSA en DLD pour détecter un volume gastrique > 1,5 mL·kg–1 et calculé les attributs du test diagnostique de la CSA en DLD pour identifier un volume gastrique > 1,5 mL·kg–1.

Résultats

L’incidence d’estomac plein était de 8/81 (9,8 %) chez les patient·es > 60 ans et 1/79 (1,2 %) chez les patient·es jeunes (différence de risque, 8,6 %; IC 95 %, 1,3 à 15,8; P = 0,03). La valeur seuil de la CSA en DLD était de 10,4 cm2 pour la détection d’un volume gastrique > 1,5 mL·kg–1 chez la patientèle > 60 ans, avec une sensibilité de 75 %, une spécificité de 100 %, une valeur prédictive positive de 100 % et une valeur prédictive négative de 98,6 %.

Conclusion

La patientèle > 60 ans devant bénéficier d’une gastroscopie sous sédation avait une incidence plus élevée d’estomac plein détecté par échographie par rapport à une cohorte plus jeune, ce qui est potentiellement associé à un risque d’aspiration plus élevé. Nous avons calculé une valeur seuil de la CSA en DLD pour détecter le volume gastrique chez les patient·es > 60 ans d’environ 10 cm2, ce qui peut aider à évaluer rapidement les personnes à risque d’aspiration.

Enregistrement de l’étude

www.chictr.org.cn (ChiCTR2100048994); enregistrée le 19 juillet 2021.

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Author contributions

Yi Zhang contributed to all aspects of this manuscript, including conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Jing Wang contributed to the conception and design of the study. Yi Cheng contributed to the acquisition of data. Jing Wang contributed to the analysis of data. Yu Shuai contributed to the interpretation of data.

Acknowledgments

Jing Wang would like to acknowledge the support of the Guizhou Provincial Health Commission and the Second Affiliated Hospital of Zunyi Medical University Award.

Disclosures

The authors have no conflicts of interest to declare.

Funding statement

This project was funded by the Guizhou Provincial Health Commission and the master’s start-up fund of the Second Affiliated Hospital of Zunyi Medical University.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Intersection of Xinglong Ave and Xinpu Ave, Zunyi, 563000, China

    Jing Wang MS, Yu Shuai MS, Yi Cheng BS & Yi Zhang MD

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This article is accompanied by an Editorial. Please see Can J Anesth 2023; https://doi.org/10.1007/s12630-023-02524-0.

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Wang, J., Shuai, Y., Cheng, Y. et al. Ultrasound assessment of gastric residual volume in patients over 60 years of age undergoing gastroscopy under sedation: a prospective cohort study. Can J Anesth/J Can Anesth 70, 1315–1322 (2023). https://doi.org/10.1007/s12630-023-02523-1

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