Use of gastric point-of-care ultrasonography to evaluate postoperative ileus

Le résumé fourni par la source

Postoperative ileus is common after colorectal surgery, occurring in 11–59% of patients1,2. It is a potential cause of aspiration pneumonia, which carries a mortality rate of up to 27%3. Although nasogastric decompression is one of the main treatments, it is not routinely recommended after surgery. Gastric point-of-care ultrasonography allows assessment of the volume and content of the stomach, which could help identify patients at risk of delayed gastrointestinal recovery and inform the timing of placement of a nasogastric tube4,5. This prospective single-centre study included 112 patients undergoing colorectal resection with or without an anastomosis between 2020 and 2023, and the aim of this study was to identify groups of patients who have the same evolution (latent trajectories) of gastric volume between the day of (laparoscopic or open) surgery and postoperative day 4. The study protocol was approved by the personal protection committee—Ile de France II (CPP) (number: 2019-A03029-48) and registered in ClinicalTrials.gov (NCT04461067). All of the patients gave their informed consent to use their data. Gastric volume was estimated from the area of the antrum according to ultrasonography. The diameter of the gastric antrum was calculated based on external diameters (anterior–posterior, d1; and right–left, d2) of the gastric antrum, upstream of the pylorus. The left lobe of the liver was used as a landmark for measurement (Fig. S1). The area was calculated using the formula d1/2 × d2/2 × pi. Measurements were taken in the fasted state daily until discharge by a junior surgeon trained by a senior radiologist. All patients undergoing colorectal surgery followed an enhanced recovery programme and oral intake was therefore not restricted (Table S1). The evolution and classification of the gastric area over time was assessed considering linear latent class mixed models, allowing both modelling data measured repeatedly over time (meaning correlated data among patients), and looking for homogeneous subgroups of patients not defined by observed variables. For these models, the patient was considered a random covariate. The number of latent classes was defined by minimizing the Akaike information criterion. All statistical tests were performed considering a P-value threshold set at 0.050, with analyses performed using R software and the lcmm library. Patient demographics and postoperative outcomes are presented in Table S2 and Table S3 respectively. The mean(s.d.) gastric area was 383.6(159.1) mm2. Latent class analysis defined two groups: those with a stable gastric volume (99 patients, 88.4%) and those with an increased gastric volume (13 patients, 11.6%) (Fig. 1), with a significant difference between groups at postoperative day 2 (P < 0.001), day 3 (P < 0.001), and day 4 (P = 0.017). Patients in the increased gastric volume group had significantly higher rates of postoperative ileus (46% versus 10%; P < 0.001) and nausea/vomiting (62% versus 14%; P < 0.001) than patients in the stable gastric volume group. Latent class analysis defining two groups of patients according to the trajectories of gastric volume P values are given at the top of the figure. NS, not significant; SGV, stable gastric volume; IGV, increased gastric volume. This study has some limitations inherent to the inclusion interval spanning the COVID-19 pandemic, requiring an extension to the intended duration; however, the main study aim was achieved. Gastric point-of-care ultrasonography can be used to identify patients with an increased gastric volume, which is associated with a higher rate of postoperative ileus. The authors have no funding to declare. The authors declare no conflict of interest. Supplementary material is available at BJS online. The data sets generated during and/or analysed during the present study are not publicly available, but are available from the corresponding author upon reasonable request. Emeline Rebmann (Data curation, Writing—review and editing), Anita Paisant (Conceptualization, Methodology, Writing—original draft, Writing—review and editing), Maxime Delestre (Data curation, Writing—review and editing), Julien Gillet (Data curation, Writing—review and editing), Elsa Parot-Schinkel (Conceptualization, Writing—original draft, Writing—review and editing), Jean-Francois Hamel (Conceptualization, Methodology, Writing—original draft, Writing—review and editing), and Aurélien Venara (Conceptualization, Methodology, Formal analysis, Writing—original draft, Writing—review and editing)

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.