Gastric contents in children presenting for upper endoscopy

Area of Science:

• Pediatric Gastroenterology
• Anesthesiology
• Aspiration Risk Assessment

Background:

• Children with gastrointestinal disorders often require sedation or anesthesia for procedures like upper endoscopy.
• Previous studies excluded these children, leaving a gap in understanding their aspiration risk.
• Accurate assessment of gastric fluid volume and pH is crucial for characterizing aspiration risk in this population.

Purpose of the Study:

• To analyze gastric fluid volume and pH in children with gastrointestinal symptoms undergoing upper endoscopy.
• To compare these findings with historical data from healthy, fasted children.
• To determine if gastrointestinal symptoms increase anesthetic aspiration risk in pediatric patients.

Main Methods:

• Prospective measurement of gastric fluid volume and pH in 248 children (2 months to 18 years) undergoing upper endoscopy.
• Standardized fasting protocols (6-8 hours) were followed for all participants.
• Gastric contents were measured endoscopically, and pH was determined using pH paper.

Main Results:

• Mean gastric fluid volume was 0.35 ± 0.45 mL/kg, with 33% exceeding 0.4 mL/kg.
• Mean gastric fluid pH was 1.37 ± 1.6, with 87% below 2.5.
• Gastric fluid volumes were highest in children presenting with abdominal pain, but overall findings were similar to historical controls.

Conclusions:

• Fasted children with gastrointestinal symptoms do not exhibit increased gastric fluid volume or acidity compared to healthy controls.
• These findings do not support the notion that children with gastrointestinal symptoms have a higher anesthetic aspiration risk.
• Standard fasting guidelines appear sufficient for managing aspiration risk in pediatric patients undergoing endoscopy, regardless of GI symptoms.