Ultrasonic Evaluation of Gastric Emptying for the Purpose of Early Resumption of Oral Ingestionafter Colorectal Cancer Surgery

Tomotake Koizumi, Akira Tsunoda, Masahiro Hayashi, Tetsuji Enosawa*, Daisuke Yasuda, Kenya Suzuki and Mitsuo Kusano

Department of General and Gastroenterological Surgery and First Department of Pathology*, Showa University School of Medicine

Background: We have attempted early resumption of oral feeding after colorectal cancer surgery by evaluating recovery from gastric ileus (GI) with the use of an opaque X-ray marker. Since this involves X-ray exposure for patients, we studied whether GI recovery could be evaluated ultrasonographically instead of by conventional radiography. Methods: (1) In 24 patients with colorectal cancer and 24 control patients, we measured the pyloric area (PA) during fasting, using ultrasonography. (2) In 6 healthy volunteers, we analyzed gastric emptying during fasting by chronologically measuring PA before and after ingestion of water and rice gruel. (3) In 24 patients with colorectal cancer, the marker (20) was orally administered at 08:00 on the first postoperative day, followed 6 hours later by abdominal plain X-ray and PA measurement. On the second and subsequent postoperative days, two tests were conducted at 09:00, and oral feeding was resumed when marker elimination exceeded 70%. Results: (1) PA during fasting did not differ significantly between colorectal cancer and control groups. (2) When PA was measured at multiple points after oral ingestion of water or rice gruel, PA returned to its preingestion level 30 minutes after ingestion of water and 240 minutes after ingestion of rice gruel. (3) The time required to resume oral ingestion after colorectal cancer surgery was 45 hours, shorter than the 48 hours required for the first gas elimination to occur postoperatively. In evaluation using the marker, 71% of all patients showed GI recovery on the second postoperative day. PA on the first postoperative day was higher than preoperatively, but returned to approximately the preoperative level on the second postoperative day, reflecting GI recovery. The time course of the marker thus appears to be identical that of PA. Conclusion: GI recovery is evaluated by ultrasonographically measuring PA.

Key words
gastric emptying, colorectal surgery, early oral feeding, ultrasonography

Reprint requests
Tomotake Koizumi Second Department of Surgery, School of Medicine, Showa University
1-5-8 Hatanodai, Shinagawa-ku, 142-8555 JAPAN

Accepted
March 28, 2007

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