Discussion
’ discomfortThe strength of this study, thirst, anxiety, OGDS, glottis, pulmonary aspiration syndrome, tiredness, volume of gastric reservoir, Carborie®
OBESE
Patients who underwent upper endoscopy are at risk to develop gastric acid aspiration into the lung because they are unable to protect their airway as endoscopic affects the glottis closure. The risk of pulmonary aspiration is higher in patient with gastric fluid greater than 0.3 ml/kg body weight (20–25 ml in adult) ml and gastric pH less than 2.5This study aimed to compare the GRV and patient’s well-being score in patients who received carbohydrate-rich beverage with plain water 2 h before gastroscopy. There was no significant difference in GRV between patients who received carbohydrate loading and plain water (4 ml and 5 ml, respectively). The European Society of Gastrointestinal Endoscopy (ESGE) guideline has recommended that patient should be fasting at least six hours of solid food and 2 h of clear fluid before the procedure for safety and complete endoscopic assessmentThe acceptance of universal “fasting guidelines” before elective surgery plays an important role in mitigating risk by limiting residual gastric contents during the immediate pre-operative period. However, these guidelines cannot be applied in patients with particular physiologic states such as pregnancy, those undergoing emergency surgery or those with coexisting medical conditionsIn our study, GRV measurement method was more accurate as it was direct aspiration and visualisation using gastroscopy. In the past study designs, measurement of GRV was made using indirect measurements either by aspiration from nasogastric tube or ultrasound assessmentObese patients were thought to have higher volume of gastric reservoir content compare to normal-weight patients due to delay gastric emptying. Thus, obese surgical patients have been presumed an increased risk of pulmonary aspiration syndrome. The available evidences on relationship of BMI and GRV were heterogenousA pre-operative prolonged fasting may result in patient's discomfort, thirst and weaknessVAS was used to assess patient’s well-being in this study as similar to other study to measure different aspect of participants’ discomfortThe strength of this study is that patient was blinded on the type of fluids taken prior to gastroscopy as both is clear fluid and tasteless. This is also a randomised controlled trial and aspirated gastric fluid was measured by direct visualisation. Our study has some limitations as it is a single center study and small sample size numbers. In our study, the assessment of GRV via direct endoscopic visualisation were patient who indicated for gastroscopy and not for long hour surgery which may far from representing a preoperative situation. The outcome of OGDS is strictly related with visibility achieved during procedure. As Carborie® is a form of clear fluid, the impact towards visibility does not affect the mucosal assessment as described in POLPREP studyIn our study, there is no significant difference in GRV and VAS well-being score for both groups. Therefore, in future practice, the patient undergoing OGDS would not need a strict fasting protocol. This data could also extrapolate in the use of maltodextrin as the pre-operative carbohydrate loading fluids prior to major surgery.In conclusion, pre-endoscopy carbohydrate rich beverage is safe to be given 2 h prior to the gastroscopy. The GRV and VAS score showed significant improvement in the patient’s well-being; hunger, thirst, anxiety, tiredness and general discomfort in both groups before and after OGDS.