A clinical study comparing ultrasound-measured pyloric antrum cross-sectional area to computed tomography-measured gastr
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ORIGINAL RESEARCH
A clinical study comparing ultrasound‑measured pyloric antrum cross‑sectional area to computed tomography‑measured gastric content volume to detect high‑risk stomach in supine patients undergoing emergency abdominal surgery Yoshifumi Okada1 · Hiroaki Toyama2 · Kenji Kamata3 · Masanori Yamauchi2 Received: 26 July 2019 / Accepted: 28 November 2019 © Springer Nature B.V. 2019
Abstract The main aim of this study was to assess whether the ultrasound examination and measurement of the pyloric antral crosssectional area (antral-CSA) in the supine position could be useful to diagnose a full stomach using a computed tomography (CT) as a comparator in emergency patients. Immediately before general anesthesia induction in patients undergoing emergency abdominal surgery, antral-CSA was measured and the volume of the gastric contents was evaluated via ultrasound in the supine position. Gastric content volume was also calculated from a CT image taken prior to the operation. The primary outcome of this study was to determine the antral-CSA threshold of the “high-risk stomach” defined as the presence of solid/ thick fluid and/or gastric content volume > 1.5 mL/kg. The secondary outcome was to evaluate the correlation between gastric content volume calculated by CT and antral-CSA. Thirty-nine patients provided consent and were included. Ten patients had gastric contents over 1.5 mL/kg, and 18 patients showed solid contents/thick fluids. The median [IQR] antral-CSA and gastric content volume were 3.82 [2.74–5.07] cm2 and 0.32 [0.09–2.08] mL/kg, respectively. The antral-CSA cutoff value of “high-risk stomach” was 3.01 cm2. This value had a sensitivity of 85%, a negative predictive value of 53%, and AUC of the ROC of 0.670 (p = 0.03). The Spearman rank-order correlation between both measures was 0.420 (p = 0.01). The correlation was improved, particularly in stomachs with solid contents/thick fluids. Antral-CSA measured in the supine position may help to assess the high-risk stomach patients undergoing emergency surgery. Trial registration: www.umin.ac.jp (UMIN 000013416). Registered 14 March 2014. Keywords Ultrasound · Cross-sectional area · Pyloric antrum · Gastric contents
1 Introduction
A summary of this article was presented in the 65th meeting of the Japanese Society of Anesthesiology. * Yoshifumi Okada [email protected] 1
Division of Anesthesia, Ishinomaki Red Cross Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi 986‑8522, Japan
2
Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
3
Division of Radiology, Ishinomaki Red Cross Hospital, Ishinomaki, Japan
During the perioperative period, it is important to prevent respiratory aspiration of gastric contents in patients with a full stomach. When patients have a full stomach in emergency surgical cases, the risk of respiratory aspiration during the induction of general anesthesia increases [1–5]. Pulmonary aspiration may result in lethal complications such as pneumoni
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