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

## TL;DR

This study shows that ultrasound can predict the risk of reflux and aspiration in diabetic patients undergoing gastroparesis surgery.

## Contribution

The study demonstrates that gastric antral ultrasound measurements are effective predictors of reflux and macro-aspiration in diabetic gastroparesis patients.

## Key findings

- Patients with reflux or macro-aspiration had significantly higher CSA, GV, and GV/W values.
- Logistic regression confirmed CSA, GV, and GV/W as significant predictors of these events.
- Ultrasound screening is recommended to reduce perioperative complications in these patients.

## Abstract

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.

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.

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%, P0.001), 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.

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.