Abstract
Preoperative fasting causes significant perioperative discomfort in patients. Preoperative oral carbohydrate (POC) is an important element of the enhanced recovery after surgery protocol, but its effect on cirrhotic patients who tend to have abnormal gastric emptying remains unclarified. We investigated the influence of POC on gastric emptying and preprocedural well-being in cirrhotic patients. A prospective, randomized, controlled study of cirrhotic patients with gastroesophageal varices scheduled for elective therapeutic endoscopy under intravenous anesthesia was conducted. We enrolled 180 patients and divided them into three groups: those not supplemented with carbohydrates for 8 h before therapeutic endoscopy (control group) and those administered a carbohydrate beverage 2 h (2 h group) and 4 h (4 h group) before endoscopy. The residual gastric volume was quantified before anesthesia, gastric emptying was evaluated using gastric ultrasonography, and preprocedural well-being was assessed using the visual analogue scale (VAS). Preanesthesia gastric sonography scores were similar among the three groups. No patient had residual gastric volume > 1.5 ml/kg in the control and 4 h groups, but six patients (11%) had a residual gastric volume of >1.5 ml/kg in the 2 h group, hence were at a risk of regurgitation and aspiration. Moreover, VAS scores for six parameters (thirst, hunger, mouth dryness, nausea, vomiting, and fatigue) in the 2 h group and three parameters (thirst, hunger, and mouth dryness) in the 4 h group were significantly lower than those in the control group, suggesting a beneficial effect on cirrhotic patients' well-being. Preoperative gastric peristaltic and operation scores, postoperative complications, length of hospital stay, and in-hospital expenses were not significantly different among the three groups. Our study indicated that avoiding preoperative fasting with oral carbohydrates administered 4 h before anesthesia can be achieved in cirrhotic patients. Further studies to assess whether POC can help improve postoperative outcomes in cirrhotic patients are needed.
Highlights
Liver cirrhosis is the end stage of chronic liver disease, and it is characterized by the accumulation of the fibrotic tissue and abnormal regenerative nodules [1, 2]
A total of 196 adult patients with cirrhosis and gastroesophageal varices hospitalized for elective therapeutic endoscopy under anesthesia between February 2019 and September 2019 were assessed for eligibility
The current study showed that preoperative carbohydrates administered 4 h prior to anesthesia could improve the wellbeing of patients with cirrhosis without increasing the risk of gastroesophageal reflux and aspiration pneumonia, suggesting the safety and promising role of Preoperative oral carbohydrates (POC) in patients with cirrhosis
Summary
Liver cirrhosis is the end stage of chronic liver disease, and it is characterized by the accumulation of the fibrotic tissue and abnormal regenerative nodules [1, 2]. Variceal hemorrhage is the most life-threatening complication of liver cirrhosis and is associated with increased mortality, in patients with hepatic decompensation [3, 4]. Therapeutic endoscopy is the recommended standard of care for the treatment and prevention of gastroesophageal variceal bleeding. It requires preprocedural fasting [5, 6]. Preoperative oral carbohydrates (POC), which avoid preoperative fasting, are widely adopted as part of the enhanced recovery after surgery (ERAS) protocol, which has shown beneficial effects in improving perioperative well-being [7].
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