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

Baseline Gastric Volume in Fasting Diabetic Patients Is Not Higher than That in Nondiabetic Patients: A Cross-sectional Noninferiority Study

“…Similarly, a recent study by Rousset et al 20 on 42 diabetic patients observed a higher incidence of full stomach, which the authors defined as either Perlas grade 2 antrum or antral cross-sectional area greater than 3.40 cm 2 (which correlates with a gastric volume of 0.8 ml/kg. However, there is growing evidence to suggest that these thresholds for at-risk stomach of 3.4 cm 2 or 0.8 ml/kg used by Rousset et al 20 and based on animal models are overly conservative for humans and may result in many “false-positive” full stomachs, being just at or below the mean values of normal baseline gastric volume in fasting individuals. 6,7 In the current study, for example, the mean antral cross-sectional area was 7.8 (3.0) cm 2 , and the mean volume was 0.9 (0.5) ml/kg in the nondiabetic control group, which is consistent with previous literature.…”

“…However, full stomach in this study was defined based only on qualitative sonographic findings (e.g., Perlas grade 2 antrum), which is a good screening method but not as accurate as doing an actual volume assessment. Similarly, a recent study by Rousset et al 20 on 42 diabetic patients observed a higher incidence of full stomach, which the authors defined as either Perlas grade 2 antrum or antral cross-sectional area greater than 3.40 cm 2 (which correlates with a gastric volume of 0.8 ml/kg. However, there is growing evidence to suggest that these thresholds for at-risk stomach of 3.4 cm 2 or 0.8 ml/kg used by Rousset et al 20 and based on animal models are overly conservative for humans and may result in many "false-positive" full stomachs, being just at or below the mean values of normal baseline gastric volume in fasting individuals.…”

“…3 To date, six published studies have evaluated fasting gastric content in diabetic patients as a surrogate marker of aspiration risk. [15][16][17][18][19][20] The findings were mixed, and researchers reached different conclusions based on what baseline contents and volumes they perceive to constitute an "at-risk" stomach.…”

“…Finally, two studies reported a higher incidence of full stomach in diabetic patients. 19,20 Zhou et al 19 studied 52 diabetic patients and reported a higher incidence of full stomach (48%) compared to nondiabetic patients (8%). However, full stomach in this study was defined based only on qualitative sonographic findings (e.g., Perlas grade 2 antrum), which is a good screening method but not as accurate as doing an actual volume assessment.…”

Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives

“…One example is diabetic gastroparesis, which primarily affects solids. 58 , 59 , 60 Gastric emptying after carbohydrate drinks is even faster in patients with type 2 diabetes than in those without diabetes. 61 Similarly, vagotomy results in rapid fluid and delayed solid emptying.…”