Endoscopic Assessment of Gastric Emptying in Older Adults After Preoperative Administration of 5% Glucose Solution: a Randomized Controlled Study

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2024 Dec 19

PMID 39695966

Authors

Yan Liu

Qian Yu

Run Wang

Linli Luo

Affiliations

Soon will be listed here.

Abstract

Background: Delayed gastric emptying of liquids may heighten the risk of aspiration reflux in elderly individuals. To investigate the gastric emptying of an oral supplement containing 5% dextrose solutions before sedation for gastroscopy.

Patients And Methods: A total of 100 elderly patients who were scheduled for elective gastroscopy were randomly assigned to two groups: the NPO(nil per os ) group and the dextrose solution ingestion group, which ingested a 5% dextrose solution (5 ml/kg) two hours before the procedure. The primary outcome measure was the gastric volume (GV) suctioned and measured during the gastroscopic examination. Secondary outcome measures included GV per weight (GV/kg), post-discharge blood glucose levels, patient discomfort assessed using the Visual Analog Scale (VAS), clarity of gastric mucosal visualization during gastroscopy, and the incidence of adverse events. Additionally, linear regression analysis was employed to identify factors influencing gastric volume.

Results: There were no significant differences in gastric volume (GV) (P=0.258) and GV per weight (GV/W) (P=0.137) between the NPO group and the dextrose solution group. However,the NPO group had higher discomfort scores on the Visual Analog Scale compared to the dextrose solution group, with a statistically significant difference(P<0.001). The clarity of gastric mucosal visualization during gastroscopy was also significantly different between the two groups(P=0.038). Blood glucose levels and the incidence of adverse events showed no significant differences between the two groups.Multivariate linear regression analysis revealed that younger age and higher functional dyspepsia symptom diary (FDSD) scores were associated with larger gastric volume, with the regression equation being: GV = 79.922 - 1.186 age + 0.556 FDSD.

Conclusion: In elderly patients, drinking 5 ml/kg of a 5 % glucose solution two hours prior to gastroscopy does not significantly increase gastric volume compared to midnight fasting.

Trial Registration: ChiCTR2100047031 (date of registration: 7 June 2021).

References

Bertoli D, Steinkohl E, Mark E, Brock C, Drewes A, Frokjaer J . Quantification of gastric emptying with magnetic resonance imaging in healthy volunteers: A systematic review. Neurogastroenterol Motil. 2022; 34(12):e14371. PMC: 10078504. DOI: 10.1111/nmo.14371. View

Jung I, Kim J, Lee H, Park H, Lee S . Endoscopic evaluation of gastric emptying and effect of mosapride citrate on gastric emptying. Yonsei Med J. 2010; 51(1):33-8. PMC: 2799979. DOI: 10.3349/ymj.2010.51.1.33. View

Joshi G, Abdelmalak B, Weigel W, Harbell M, Kuo C, Soriano S . 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of.... Anesthesiology. 2023; 138(2):132-151. DOI: 10.1097/ALN.0000000000004381. View

Kotani K, Kawabe J, Kawamura E, Kawano N, Emoto M, Yoshida A . Clinical assessment of delayed gastric emptying and diabetic complications using gastric emptying scintigraphy: involvement of vascular disorder. Clin Physiol Funct Imaging. 2013; 34(2):151-8. DOI: 10.1111/cpf.12079. View

Early D, Lightdale J, Vargo 2nd J, Acosta R, Chandrasekhara V, Chathadi K . Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018; 87(2):327-337. DOI: 10.1016/j.gie.2017.07.018. View

Zhang Z, Wang R, Duan B, Cheng Z, Wang E, Guo Q . Effects of a Preoperative Carbohydrate-Rich Drink Before Ambulatory Surgery: A Randomized Controlled, Double-Blinded Study. Med Sci Monit. 2020; 26:e922837. PMC: 7477936. DOI: 10.12659/MSM.922837. View

Jeong J, Ahn J, Shim J, Lee S, Ryu K, Lee S . Gastric emptying of preoperative carbohydrate in elderly assessed using gastric ultrasonography: A randomized controlled study. Medicine (Baltimore). 2021; 100(37):e27242. PMC: 8448003. DOI: 10.1097/MD.0000000000027242. View

Fawcett W, Thomas M . Pre-operative fasting in adults and children: clinical practice and guidelines. Anaesthesia. 2018; 74(1):83-88. DOI: 10.1111/anae.14500. View

Asl S, Sivandzadeh G . Efficacy of premedication with activated Dimethicone or N-acetylcysteine in improving visibility during upper endoscopy. World J Gastroenterol. 2011; 17(37):4213-7. PMC: 3208366. DOI: 10.3748/wjg.v17.i37.4213. View

10.

Gultekin Y, Kilic O, Ozcelik Z, Toprak S, Bayram R, Arun O . Can Gastric Volume be Accurately Estimated by Ultrasound?. Turk J Anaesthesiol Reanim. 2022; 50(3):194-200. PMC: 9361396. DOI: 10.5152/TJAR.2022.21341. View

11.

Perlas A, Mitsakakis N, Liu L, Cino M, Haldipur N, Davis L . Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg. 2013; 116(2):357-63. DOI: 10.1213/ANE.0b013e318274fc19. View

12.

Tan Y, Wang X, Yang H, Pan C, Luo N, Li J . Ultrasonographic assessment of preoperative gastric volume in patients with dyspepsia: a prospective observational study. BMC Anesthesiol. 2022; 22(1):21. PMC: 8753825. DOI: 10.1186/s12871-021-01559-4. View

13.

Van de Putte P, Perlas A . The link between gastric volume and aspiration risk. In search of the Holy Grail?. Anaesthesia. 2017; 73(3):274-279. DOI: 10.1111/anae.14164. View

14.

Wang Z, Ding W, Fang Q, Zhang L, Liu X, Tang Z . Effects of not monitoring gastric residual volume in intensive care patients: A meta-analysis. Int J Nurs Stud. 2019; 91:86-93. DOI: 10.1016/j.ijnurstu.2018.11.005. View

15.

Cho E, Huh J, Lee S, Ryu K, Shim J, Cha Y . Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study. Anesth Analg. 2021; 133(3):690-697. DOI: 10.1213/ANE.0000000000005411. View

16.

Lamperti M, Romero C, Guarracino F, Cammarota G, Vetrugno L, Tufegdzic B . Preoperative assessment of adults undergoing elective noncardiac surgery: Updated guidelines from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2024; 42(1):1-35. DOI: 10.1097/EJA.0000000000002069. View

17.

Aguilar-Nascimento J, Caporossi C, Metelo J, Tanajura G, Canevari-de-Oliveira M, da Cunha Costa R . Safe intake of an oral supplement containing carbohydrates and whey protein shortly before sedation to gastroscopy; a double blind, randomized trial. Nutr Hosp. 2014; 29(3):681-6. DOI: 10.3305/nh.2014.29.3.7161. View

18.

Gianotti L, Biffi R, Sandini M, Marrelli D, Vignali A, Caccialanza R . Preoperative Oral Carbohydrate Load Versus Placebo in Major Elective Abdominal Surgery (PROCY): A Randomized, Placebo-controlled, Multicenter, Phase III Trial. Ann Surg. 2017; 267(4):623-630. DOI: 10.1097/SLA.0000000000002325. View

19.

Attila T, Hellman R, Krasnow A, Hofmann C, Saeian K, Dua K . Feasibility and safety of endoscopic evaluation of gastric emptying. Endoscopy. 2005; 37(3):240-3. DOI: 10.1055/s-2004-826196. View

20.

Shin H, Koo B, Lim D, Na H . Ultrasound assessment of gastric volume in older adults after drinking carbohydrate-containing fluids: a prospective, nonrandomized, and noninferiority comparative study. Can J Anaesth. 2022; 69(9):1160-1166. DOI: 10.1007/s12630-022-02262-9. View