Ultrasound assessment of gastric content in fasted patients before elective laparoscopic cholecystectomy: a prospective observational single-cohort study

Abstract

Background: Patients with symptomatic gallbladder diseases exhibit delayed gastric emptying. We evaluated the residual gastric content in fasted patients scheduled for elective laparoscopic cholecystectomy because of symptomatic gallbladder disease using ultrasonography. Methods: This prospective observational single-cohort study was approved by the Institutional Review Board, and written informed consent was obtained from all included patients. Before anesthesia induction, the gastric antrum was examined by ultrasound. Once the presence of solid content was excluded, the patients were classified using a three-point grading system (grade 0: no fluid; grade 1: fluid in the right lateral decubitus position; grade 2: fluid in both the supine and right lateral decubitus positions), and the fluid volume was measured. A stomach was considered empty if it had no contents or ≤ 1.5 mL·kg−1 of fluid, and was considered full if solid content or > 1.5 mL·kg−1 of fluid was detected. Results: Among 138 patients, 18 patients (13%) presented with a full stomach, 12 (9%) of whom had solid content, and six (4%) of whom had >1.5 mL·kg−1 of fluid in their stomach. Among the remaining 120 patients with an empty stomach, 65 patients presented with a grade 0 antrum, and 55 patients with a grade 1 or 2 antrum with ≤ 1.5 mL·kg−1 of fluid. Conclusion: The gastric ultrasound assessment revealed that 13% of patients scheduled for elective cholecystectomy because of symptomatic gallbladder disease had a full stomach despite following the fasting guidelines. This was higher than the reported incidence of a full stomach among the general surgical population. Further studies are required to delineate the clinical implications of our findings. Trial registration: www.ClinicalTrials.gov (NCT03259841); registered 4 August, 2017.