Beyond Fasting Guidelines: The Diabetic Stomach under Ultrasound Probe
Ketaki Marodkar *
Department of Anaesthesiology, NKPSIMS & RC and LMH, Nagpur, India.
Sampreeti Dungala
Department of Anaesthesiology, NKPSIMS & RC and LMH, Nagpur, India.
Sourabh Vyas
Department of Anaesthesiology, NKPSIMS & RC and LMH, Nagpur, India.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Aspiration of gastric contents remains a significant perioperative concern, particularly in patients with diabetes mellitus, who are predisposed to delayed gastric emptying owing to autonomic neuropathy and gastroparesis. Despite adherence to standard preoperative fasting guidelines, variability in gastric residual volume (GRV) persists. Point-of-care ultrasound (POCUS) has emerged as a reliable, non-invasive bedside modality for assessing gastric contents and stratifying aspiration risk.
Aims: The aim of the study was to evaluate the association of POCUS-guided preoperative fasted gastric volume with duration of diabetes and body mass index (BMI) in diabetic patients.
Methods: This prospective analytical cross-sectional study included 112 adult diabetic patients scheduled for elective surgery under general anaesthesia. Gastric ultrasonography was performed in both supine and right lateral decubitus positions using a curvilinear probe. Antral cross-sectional area (CSA) was measured, and GRV was calculated using the Perlas formula (Perlas et al., 2013). Patients were stratified according to duration of diabetes and BMI. Statistical analysis included independent t-tests, ANOVA and multivariable regression.
Results: The mean GRV was 47.54 ± 16.03 mL, with a mean antral CSA of 5.56 ± 1.56 cm². A progressive increase in GRV was observed with increasing duration of diabetes, rising from 38.59 ± 16.48 mL in patients with less than five years of disease to 111.28 ± 1.35 mL in those with more than 20 years (p < 0.001). BMI demonstrated an increasing trend in GRV; however, this was not statistically significant (p = 0.206). Multivariable regression analysis confirmed that both duration of diabetes (β = 2.37; p < 0.001) and BMI (β = 0.63; p = 0.001) independently predicted higher GRV.
Conclusion: POCUS provides a practical tool for preoperative gastric assessment in diabetic patients. Longer disease duration and higher BMI are associated with increased gastric volume, underscoring the importance of individualised perioperative risk assessment.
Keywords: Point-of-care ultrasound, gastric residual volume, diabetic gastroparesis, diabetes mellitus, body mass index, gastric ultrasonography