Related Experiment Video
Updated: Aug 7, 2025
Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Preoperative clear fluid fasting and endoscopy-measured gastric fluid volume in children
Gabriella Aschkenasy1, Oren Leder2, Rivka Pardes1
1Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
New research indicates that clear fluid fasting times before anesthesia in children do not significantly correlate with residual gastric volume. This finding supports recommendations to shorten fasting periods for pediatric patients undergoing procedures.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Perioperative Care
Background:
- Current guidelines recommend specific fasting times for clear fluids before anesthesia.
- New recommendations suggest shortening these fasting periods.
- The impact of shorter fasting times on gastric residual volume in children requires further investigation.
Purpose of the Study:
- To explore the correlation between varying clear fluid fasting times and residual gastric fluid volume in children.
- To quantify gastric fluid volume and acidity through direct endoscopic aspiration.
- To inform evidence-based adjustments to pediatric fasting protocols.
Main Methods:
- A prospective, single-center study involving pediatric patients aged 1-18 years undergoing elective gastroscopy.
- Direct endoscopic aspiration of gastric contents to measure residual volume and pH.
- Collection of data on patient fasting times, last intake, and patient characteristics.
Main Results:
- 253 gastroscopies were analyzed in 245 children, with a mean clear fluid fasting time of 6.9 hours.
- Mean residual gastric volume was 0.34 mL/kg, with a mean pH of 1.5.
- No significant correlation was found between clear fluid fasting time and residual gastric volume per kg body weight (r = -.103, p = .1) or gastric fluid pH (r = -.07, p = .3).
Conclusions:
- No association was demonstrated between clear fluid fasting time and residual gastric fluid volume in children undergoing gastroscopy.
- The findings suggest that current clear fluid fasting times may be unnecessarily long.
- This study supports the potential to shorten clear fluid fasting times in pediatric patients without compromising safety.
Background:
In light of new recommendations to shorten clear fluid fasting time before anesthesia, our study aimed at exploring residual fluid volume in the stomach after different fasting times. We intended to perform direct endoscopic aspiration of stomach contents under vision, as part of routine gastroscopy assessment. Hereby we would be able to quantify true residual gastric fluid volume and acidity in children and measure their correlation with fasting times.
Methods:
The study was performed as a single-center, prospective study in pediatric perioperative day care at a university-affiliated tertiary care center. Aspiration of gastric fluid contents was performed in anesthetized children aged 1-18 years undergoing an elective gastroscopy. Recorded data included patient fast time, last meal content, last clear fluid content, and aspirated gastric volume and pH, as well as patient characteristics.
Results:
We included 253 gastroscopies, performed in 245 children. Mean fasting time for clear fluids was 6.9 h (range 1 h 40 min - 18 h 35 min) (SD 4.5). Mean age was 9.8 years (SD 5.1) and mean body weight was 33.2 kg (SD 18.7). Mean residual gastric volume was 12 mL (0-90) (SD 13.5) or 0.34 mL/kg (SD 0.37) and mean pH was 1.5 (SD 0.9). No significant correlation was observed between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight (r = -.103, p = .1), nor between clear fluid fasting time and the pH of the residual gastric fluid (r = -.07, p = .3). In more than half of the patients the residual gastric volume was less than 10 mL, unrelated to fasting time.
Conclusions:
In children undergoing gastroscopy, we could not demonstrate any association between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight. Since we did not see a clinically relevant association between clear fluids fasting time and gastric residual volume, this study may support the recommendation to shorten clear fluids fasting time.
Related Concept Videos
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:28Endoscopic Procedures III: Video Capsule Endoscopy
01:26Endoscopic Procedures V: ERCP
Patient...
01:16Gastric Emptying
01:19Urodynamic Studies: Uroflowmetry