• Yoshifumi Okada, Hiroaki Toyama, Kenji Kamata, and Masanori Yamauchi.
• Division of Anesthesia, Ishinomaki Red Cross Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi, 986-8522, Japan. ZVS11433@nifty.com.
• J Clin Monit Comput. 2020 Oct 1; 34 (5): 875-881.

AbstractThe main aim of this study was to assess whether the ultrasound examination and measurement of the pyloric antral cross-sectional 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.

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