ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 January-February;88(1-2):23-31

DOI: 10.23736/S0375-9393.21.15603-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Ultrasound assessment of the gastric content among diabetic and non-diabetic patients before elective surgery: a prospective multicenter study

Julien ROUSSET ^{1, 2, 3} ✉, Zoe COPPERE ⁴, Alexandre VALLEE ^{3, 5}, Sabrina MA ^{2, 3}, Simon CLARIOT ^{1, 4}, Julien BUREY ¹, Sherifa ADJAVON ^{2, 3}, Jean M. DEVYS ⁴, Christophe QUESNEL ^{1, 6}, Marc FISCHLER ^{2, 3}, Francis BONNET ^{1, 6}, Morgan LE GUEN ^{2, 3}

¹ Department of Anesthesiology and Perioperative Medicine, Tenon Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; ² Department of Anesthesiology, Foch Hospital, Suresnes, France; ³ Versailles-Saint-Quentin-en-Yvelines Hospital, Versailles, France; ⁴ Department of Anesthesiology, Adolphe de Rothschild Foundation, Paris, France; ⁵ Foch Hospital, DRCI, Suresnes, France; ⁶ Sorbonne University, Faculty of Medicine Paris VI, Paris, France

BACKGROUND: Although diabetic gastroparesis could be responsible for delayed gastric emptying, there is conflicting evidence about the volume of gastric content in diabetic patients after preoperative fasting. We hypothesized that diabetic patients had an increased gastric content before anesthesia induction despite the following of fasting recommendations. We used ultrasound assessment of gastric content to evaluate this risk.
METHODS: This multicenter prospective single-blinded case-control study was conducted in three teaching University hospital in France. Our primary outcome was the comparison of increased gastric content between the two groups and was defined either by a Perlas grade 2 antrum or an antral cross-sectional area (CSA)>340 mm². Each diabetic patient was paired with three non-diabetic control patients. Forty-two diabetic and 126 control patients were included in the study.
RESULTS: Eighteen (42.9%) diabetic patients reached the primary outcome versus 28 (22.2%) in the control group (P=0.009). Diabetic patients presented less frequently with an empty stomach. Indeed, ten (23.8%) diabetic patients had a grade 0 antrum versus 71 (56.3%) in the control group (P<0.001). Twenty-four (70.6%) diabetic patients had an antral CSA<340 mm² versus 98 (86%) in the control group (P=0.039). Overall, diabetic patients and increased gastric content were associated with an Odds Ratio, 2.63; 95% confidence interval, 1.25-5.52, P=0.009.
CONCLUSIONS: Our study documents that gastric content is increased among diabetic patients compared to control patients despite following appropriate fasting guidelines.

KEY WORDS: Gastroparesis; Ultrasonography; Gastric emptying