Preoperative Ultrasonographic Assessment of the Gastric Antrum in Diabetic Patients Before Elective Surgery: A Prospective Observational Comparative Cohort Study.

Background: Diabetic patients may have neuropathy-induced gastroparesis predisposing them to aspiration. Point-of-care gastric ultrasonography (GUSG) is useful in the qualitative assessment of the antrum and quantitative prediction of gastric volume (GV) in diabetic patients. In this study, we compared the GUSG findings between fasting diabetic and non-diabetic patients in the elective preoperative setting.

Methods: A total of 220 patients were included in the study with 110 diabetic patients in the diabetes mellitus (DM) group and 110 non-diabetic patients in the non-diabetes mellitus (NDM) group. GUSG was performed in supine and right lateral decubitus (RLD) positions and qualitative grading was done. An empty antrum in both supine and RLD positions was graded 0. Fluid present in the RLD position but empty in the supine position was graded 1. The presence of solids or fluid in both supine and RLD positions was graded 2. Quantitative assessment was done by calculating the estimated GV using the measured cross-sectional area (CSA). The presence of grade 2 antrum or solids or GV >0.8 mL/kg was considered as criteria for a 'high-risk' antrum.

Results: Grade 2 antrum was found in 18% of patients in the diabetic group compared to 3% in the non-diabetic group. Mean CSA (5.65 cm) and mean GV (34.52 mL) were significantly higher in diabetic patients. Forty-one (37.2%) patients among the diabetic patients had a high-risk antrum and a potentially higher risk of aspiration when compared to non-diabetic patients. Higher age and female gender were found to be associated with the incidence of 'high-risk' antrum in the univariate logistic regression model.

Conclusion: Diabetic patients have a higher incidence of grade 2 antrum, and higher CSA and GV, when compared to non-diabetic patients. Risk factors such as female gender and increasing age are associated with the high-risk antrum incidence. Further studies where objective tests are done to identify the presence of diabetic autonomic neuropathy might help determine the relationship between GUSG and aspiration risk.