2026/05/06 by Evan Michell, Andrew Lange, Erez Ben‐Menachem · 1 voice
Medicine · #Gastroesophageal reflux and treatments #Diabetes Treatment and Management #Gastrointestinal motility and disorders
paper · doi:10.1111/anae.70220
openalex publication_date 2026/05/06 · openalex created_date 2026/05/08 · openalex updated_date 2026/06/18
Vlaeminck et al. report gastric ultrasound findings in patients receiving semaglutide treatment for diabetes mellitus or weight loss [1]. They showed persistently elevated pulmonary aspiration risk compared with matched controls. In addition, they found that gastric ultrasound findings modified management in >50% of these patients. We agree with the authors' conclusion that gastric ultrasound should be used as part of a comprehensive assessment to guide anaesthetic management of patients receiving glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Guidelines published by the Association of Anaesthetists, Australian and New Zealand College of Anaesthetists and American Society of Anesthesiologists also endorse this view [2-4]. Given the growing body of evidence supporting gastric ultrasound use in these patients, at our tertiary teaching hospital, we distributed a survey to 90 resident and consultant anaesthetists regarding their gastric ultrasound practice to better understand current usage (Table 1). The survey was undertaken in February 2026 and we received 56 (62%) responses. Our primary survey question was whether respondents use gastric ultrasound when assessing a patient receiving GLP-1 RAs who has not undertaken a 24-h clear fluid diet. This question was chosen as local guidelines recommend explicitly the use of gastric ultrasound in these patients, with clear directions as to how these results affect management [3]. We found that only 24 (43%) of respondents would use gastric ultrasound in this scenario. This is unsurprising, given 2 (4%) respondents reported feeling ‘very comfortable’ and 12 (21%) felt ‘somewhat comfortable’ performing and interpreting gastric ultrasound independently. Respondents who would use gastric ultrasound were more likely to be ‘somewhat comfortable’ or ‘very comfortable’ than those who would not (10, 42% vs. 4, 13%, respectively). This suggests that a lack of comfort contributes to the discrepancy between actual and recommended gastric ultrasound use. This was reinforced further through respondents' self-identified barriers to using gastric ultrasound. ‘Skill decay’ was identified by 33 (59%), ‘inadequate training’ by 31 (55%) and ‘time pressure’ by 28 (50%). Other barriers were identified less frequently, such as ‘lack of evidence’ (8, 14%), ‘makes no difference to my practice’ (8, 14%) and ‘lack of ultrasound machines’ (14, 25%). While 46 (82%) respondents had received some form of training in gastric ultrasound, those who would use gastric ultrasound were more likely to have received training during their registrar training than those who would not (10, 42% vs. 5, 16%, respectively). Similarly, respondents who would use gastric ultrasound were more likely to have performed or interpreted supervised gastric ultrasound studies than respondents who would not (12, 50% vs. 10, 31%, respectively). Our survey highlights that, despite recommendations and a growing body of evidence supporting gastric ultrasound use in assessing inadequately fasted patients receiving GLP-1 RAs, only a minority of respondents would use gastric ultrasound clinically. These data suggest a gap between sufficient training, skill maintenance and accruing evidence and recommendations. Future research should focus on the potential benefits of gastric ultrasound and how to best train and support anaesthetists to incorporate gastric ultrasound into routine clinical practice. Including gastric ultrasound as a core skill in speciality training and designating departmental gastric ultrasound ‘champions’ should be considered. Until systematic efforts are made to improve gastric ultrasound capabilities in clinical practice, there is likely to be an ongoing gap between evidence for and clinical usage of this important modality.