The Application of Ultrasonography in Risk Assessment of Reflux and Aspiration in Diabetes Patients Undergoing Gastroparesis Surgery

Abstract

Background: Diabetic gastroparesis increases the risk of reflux and macro-aspiration during surgery. This study evaluated the predictive role of gastric antral ultrasound in identifying these events in diabetic gastroparesis patients undergoing surgical procedures. Materials and Methods: A cross-sectional study was conducted on 60 diabetic gastroparesis patients at Binhai County People’s Hospital (June 2023–June 2025). Gastric antral ultrasound was performed using a SonoSite M-Turbo system, measuring cross-sectional area (CSA), gastric volume (GV), and GV-to-weight ratio (GV/W). Reflux was defined as pharyngeal pH >4, and macro-aspiration was confirmed via bronchial assessment. Statistical analysis (SPSS 27.0) included independent t-tests, chi-square tests, and logistic regression. Results: Among 60 patients (34 male, 26 female; mean age 48.19 ± 7.23 years), 9 (15%) experienced reflux (n=6) or macro-aspiration (n=3). Patients with events had significantly higher CSA (3.28 ± 0.35 vs. 3.07 ± 0.29 cm², P=0.038), GV (12.15 ± 3.28 vs. 10.12 ± 2.76 mL, P=0.013), and GV/W (0.17 ± 0.05 vs. 0.15 ± 0.04 mL/kg, P=0.022). Postoperative SpO2 was lower (94.89 ± 2.11% vs. 97.45 ± 1.88%, P<0.001), and gastric protease levels were higher (62.78 ± 10.92 vs. 55.88 ± 11.34 ng/mL, P=0.006) in affected patients. Logistic regression confirmed CSA (OR=1.45, 95% CI: 1.02–2.06, P=0.039), GV (OR=1.22, 95% CI: 1.04–1.43, P=0.015), and GV/W (OR=1.38, 95% CI: 1.03–1.85, P=0.031) as significant predictors. Conclusion: Gastric antral ultrasound effectively predicts reflux and macro-aspiration risk in diabetic gastroparesis patients, with elevated CSA, GV, and GV/W serving as key indicators. These findings support preoperative ultrasound screening to mitigate perioperative complications.