Pre-operative Ultrasound Assessment of Gastric Contents in Diabetic and Non-diabetic Patients Undergoing Elective Surgery: A Cross-sectional Analytical Study

Abstract

Background: Pulmonary aspiration remains a potentially catastrophic perioperative complication. Although current fasting guidelines reduce aspiration risk in most patients, delayed gastric emptying is frequently encountered in patients with diabetes mellitus because of autonomic neuropathy and diabetic gastroparesis. Consequently, standard fasting periods may not reliably ensure an empty stomach in diabetic patients. Point-of-care gastric ultrasonography has emerged as a rapid, non-invasive bedside tool for qualitative and quantitative assessment of gastric contents and may facilitate individualized anesthetic planning. Objectives: The objective of the study was to compare pre-operative gastric antral cross-sectional area (CSA), estimated gastric volume, qualitative gastric contents, and aspiration risk between diabetic and non-diabetic patients undergoing elective surgery using bedside gastric ultrasonography. Materials and Methods: A hospital-based cross-sectional analytical study was conducted in 100 adult patients scheduled for elective surgery. Fifty diabetic patients (Group D) and 15 non-diabetic patients (Group ND) who complied with standard fasting guidelines underwent pre-operative gastric ultrasonography using a 3–5 MHz curvilinear probe. Gastric antral CSA was measured in both the supine and right lateral decubitus (RLD) positions. Estimated gastric volume was calculated using the validated Perlas formula. Gastric contents were graded qualitatively according to the Perlas grading system, and aspiration risk was categorized accordingly. Statistical analysis was performed using Student’s t-test and Chi-square test, with P < 0.05 considered statistically significant. Results: Diabetic patients demonstrated significantly larger gastric antral CSA in both the supine (5.88 ± 0.53 cm2 vs. 3.25 ± 0.34 cm2; P < 0.001) and RLD positions (7.32 ± 0.87 cm2 vs. 3.78 ± 0.42 cm2; P < 0.001). Estimated gastric volume was significantly greater in diabetic patients than non-diabetic patients (58.69 ± 17.63 mL vs. 25.28 ± 16.85 mL; P < 0.001). Grade 2 stomachs were identified exclusively among diabetic patients (12%), whereas none of the non-diabetic patients demonstrated high-risk gastric contents. High aspiration risk was observed in 12% of diabetic patients compared with 0% of non-diabetic patients (P = 0.012). Conclusion: Despite adherence to standard fasting guidelines, diabetic patients exhibited significantly greater residual gastric volume and a higher prevalence of high-risk gastric contents than non-diabetic patients. Bedside gastric ultrasonography provides a valuable individualized assessment of gastric contents and may improve perioperative risk stratification and anesthetic decision-making in diabetic patients.