Ultrasonographic assessment of the effects of cholelithiasis and cholecystectomy on gastric emptying: a prospective observational cohort study

Ultrasonographic assessment of the effects of cholelithiasis and cholecystectomy on gastric emptying: a prospective observational cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ultrasonographic assessment of the effects of cholelithiasis and cholecystectomy on gastric emptying: a prospective observational cohort study Xinna Lu, Wentao Lu, Yu Huang, Xiaowei Song, Keting Wu, Dejuan Shen, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8434062/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background Cholelithiasis is a prevalent biliary tract disorder, and cholecystectomy serves as a primary treatment modality. However, the impact of cholelithiasis and cholecystectomy on gastric emptying remains unclear. Ultrasound is a user-friendly, non-invasive measurement tool. The study aims to assess the effects of cholelithiasis and cholecystectomy on gastric emptying by ultrasonically measuring the cross-sectional area (CSA) of the gastric antrum. Methods Patients (n = 100) were divided into the cholelithiasis (CH) group, post-cholecystectomy (PC) group and healthy volunteer (HV) group (n = 30 each). The participants underwent an assessment of dyspepsia scores over the past nearly 3 months and drank a semi-solid test meal (300 kcal) after fasting. The following gastric emptying parameters were quantified ultrasonographically by the cross-sectional area (CSA) of the gastric antrum at baseline (T0) and at 5, 15, 30, 45, 60, 90, and 120 min after meal ingestion (T1 to T7): gastric emptying fractions at T5, T6, and T7, as well as the gastric half-emptying time. Results Compared with the HV group, both the CH and PC groups showed a significant increase in CSA from T3 to T7 (P < 0.05), and the CSA of the PC group from T4 to T7 was larger compared with the CH group (P < 0.05). Compared with the HV group, both the CH and PC groups exhibited significantly higher dyspepsia scores and impaired gastric emptying, as evidenced by lower gastric emptying fractions at T5, T6, and T7, and a prolonged gastric half-emptying time (P < 0.05). There was no significant difference in the dyspepsia scores between the CH group and the PC group. However, compared with the CH group, the PC group exhibited significantly lower gastric emptying fractions at T5 T6, and T7, as well as a longer gastric half-emptying time (P < 0.05). Conclusion Ultrasound assessment showed that compared with healthy volunteers, both patients with cholelithiasis and those after cholecystectomy had longer gastric emptying times, with the delay being more significant in the latter. Trial registration: www.chictr.org.cn (20/09/2022 ChiCTR2200063900) Cholelithiasis Cholecystectomy Gastric emptying Healthy volunteers Figures Figure 1 Figure 2 Figure 3 Background Cholelithiasis refers to the formation of stones in the gallbladder or biliary tract, which is a common condition of the digestive system. These stones are primarily composed of cholesterol, bile pigments, or mixed components, and may lead to biliary obstruction, inflammation, or infection[1]. Multiple studies have conclusively demonstrated that cholelithiasis induces delayed gastric emptying[2–6]. The underlying mechanism may involve dysregulation of circulating gastric hormones and cholecystokinin due to impaired bile concentration, storage, and emptying functions, or alternatively, prolonged gastric emptying time mediated through complex neurohormonal pathways[5]. Cholecystectomy remains the primary treatment for cholelithiasis[7]. In contrast to the well-established effects of gallstones on gastric emptying, post-cholecystectomy alterations in gastric motility continue to demonstrate inconsistent findings in clinical studies.Early studies generally suggested that cholecystectomy could improve gastric emptying function[2,3]. However, subsequent research has shown significant inconsistencies in findings. A 2013 prospective study by Dinesh Bagaria et al. demonstrated that cholecystectomy did not significantly affect gastric emptying time[4]. A more recent study has even found that post-cholecystectomy patients exhibited further deterioration in gastric emptying function compared to those with cholelithiasis[5]. Therefore, the impact of cholecystectomy on gastric motility requires further investigation. Delayed gastric emptying holds significant clinical implications in the perioperative period. On one hand, it increases the risk of aspiration during anesthesia, with recent evidence suggesting that this risk may persist even when standard fasting protocols are followed[8]. On the other hand, postoperative delayed gastric emptying can prolong hospital stays, reduce quality of life, and increase economic burdens[9]. Since delayed gastric emptying is more common in individuals with underlying conditions such as diabetes and obesity, as well as those with a history of gastric surgery[10], clinical attention to changes in gastric emptying in patients with cholelithiasis and those undergoing cholecystectomy remains insufficient. Moreover, research on the impact of cholelithiasis and cholecystectomy on gastric emptying is relatively scarce. Methods for measuring gastric emptying include scintigraphy, 13 C-urea breath test, ultrasonography, magnetic resonance imaging (MRI), wireless motility capsule, acetaminophen absorption test, electrogastrography (EGG), and electrical impedance tomography (EIT)[11]. Among these, scintigraphy has remained the gold standard due to its high accuracy[12]. However, this method presents several limitations including radiation exposure, high cost, and requirements for specialized equipment and facilities[13]. Ultrasonography has become an alternative to scintigraphy due to its advantages of being non-invasive, radiation-free, operationally convenient, cost-effective, capable of differentiating between liquid and solid emptying, and providing real-time dynamic assessment[14–16]. Moreover, A study of 128 participants (92 healthy volunteers and 36 diabetic patients) found that ultrasound measurements strongly correlated with scintigraphy and showed no significant difference in accuracy compared to scintigraphy[17]. Ultrasonographic assessment of gastric emptying primarily involves measuring the cross-sectional area (CSA) of the antrum, as antral CSA exhibits a strong correlation with intragastric food residue volume[18,19]. This method provides an accurate estimation of gastric content volume, with its reliability and reproducibility well-documented in multiple studies[20–22]. An additional advantage of antral CSA measurement lies in the consistent anatomical position and clearly defined boundaries of the antrum, facilitating precise localization[23]. Currently, a series of studies on the effects of cholelithiasis on gastric motility suggest negative impacts, though the underlying mechanisms require further clarification. The influence of cholecystectomy on gastric emptying remains unclear. Ultrasonographic measurement of the antral cross-sectional area (CSA) enables accurate assessment of gastric emptying function. Therefore, we conducted a prospective controlled trial to evaluate the effects of cholelithiasis and cholecystectomy on gastric emptying using ultrasound, providing new evidence for clinical assessment of gastric emptying. Methods Study design This prospective observational study was approved by the Ethics Committee of the Northern Jiangsu People's Hospital (2022ky252) and registered in the Chinese Clinical Trial Registry (ChiCTR2200063900). Written informed consent was obtained from all participants. A total of 100 subjects were recruited in this study from Northern Jiangsu People’s Hospital between September 2022 and November 2022, including the healthy volunteer (HV) group, cholelithiasis (CH) group, and post-cholecystectomy (PC) group. This work has been reported in line with observational studies (STROBE) guidelines [24] and the principles of the Declaration of Helsinki[25]. Participants The inclusion criteria were as follows: (1) aged between 18–64 years; (2) American Society of Anesthesiologists (ASA) physical status of I to II; (3) body mass index between 18–30 kg/m 2 . The exclusion criteria were as follows: (1) suffering from cardiac, renal or hepatic dysfunction (2) severe metabolic, endocrine or electrolyte disorders (e.g., diabetes mellitus) (3) high risk of regurgitation and aspiration (e.g., achalasia of the cardia, pyloric obstruction, digestive obstruction, etc.); (4) history of gastrointestinal, hepatic and pancreatic diseases, and abdominal surgeries; (5) Cognitive or psychiatric impairment limiting cooperation; (6) Inability to assume the right lateral decubitus position; (7) lactose intolerance. Study protocol Study protocol Pre-enrollment preparation and fasting confirmation Before enrollment, patients were tested to ensure they had not taken any medications that could affect gastrointestinal function for three days prior. We assessed all participants' dyspepsia scores over the past 3 months. Specific scores were based on the weekly frequency and severity of postprandial fullness and discomfort, early satiety, mid-upper abdominal pain, and mid-upper abdominal burning, up to a maximum of 36 points[26]. They were required to fast for at least 8 hours and abstain from drinking for 6 hours before consuming the test meal. The fasting state was confirmed by gastric ultrasonography, which showed the stomach in a flattened shape in the sagittal plane with the anterior and posterior walls close to each other, appearing as a "target sign." In the coronal plane, it appeared as a "ring sign"[19]. Selection of the test meal Participants were required to consume 250 g of yogurt within 5 minutes. The macronutrient composition consisted of 6.4 g of protein (accounting for 8% of total energy), 7.2 g of fat (9%), and 29.0 g of carbohydrate (36%), with a total energy content of 300 kcal. Yogurt was selected as the test meal in this study for the following reasons: (1) as a semi-solid meal, it balances physiological relevance and feasibility for ultrasound measurements[27]; (2) it offers good patient tolerance and high safety; (3) the 300 kcal energy content is sufficient to stimulate gastric emptying responses without excessively prolonging emptying time[28]. Ultrasonic localization Gastric ultrasound examinations were performed on all patients using an ultrasound system equipped with a 2–5 MHz curved array transducer (manufactured by Sonosite Ultrasonic Fujifilm Investment Co., LTD, China). The left lobe of the liver, pancreas, inferior vena cava, and superior mesenteric vein were used as anatomical landmarks for locating the gastric antrum in the sagittal plane of the epigastric region. The gastric antrum was identified immediately posterior to the left lobe of the liver and anterior to the pancreas, while the transducer was positioned along the sagittal plane of the epigastric region. Measurement of CSA For quantitative assessment, the patient was placed in the right lateral decubitus position at a 45° angle. A convex probe was positioned perpendicular to the longitudinal axis of the gastric antrum and tilted clockwise or counterclockwise to obtain the minimal circular cross-sectional view of the antrum. The cross-sectional area (CSA) of the gastric antrum was calculated using the ellipse area formula: CSA = (AP × CC × π)/4(AP = anteroposterior diameter and CC = cranio-caudal diameter) [29]. Diameters were measured from serosa to serosa during the gastric intercontractile phase. Three measurements were taken for each patient, and the average value was used for analysis (Fig. 1 ). Landmarks: L, liver; P, pancreas; AP, anteroposterior diameter; CC, craniocaudal diameter. Assessment of gastric emptying The following gastric emptying parameters were quantified ultrasonographically by the cross-sectional area (CSA) of the gastric antrum at baseline (T0) and at 5, 15, 30, 45, 60, 90, and 120 min after meal ingestion (T1 to T7): gastric emptying fractions at T5, T6, and T7, as well as the gastric half-emptying time. Gastric emptying score for a given period = [1 - (CSA for a given time period ÷ 15 min CSA)] × 100 [30]. The gastric half-emptying time is defined as the time required for 50% of gastric contents to empty [31]; recording the gastric emptying fraction at T 7 . Gastric ultrasound measurements and interpretations were performed by the independent researcher proficient in bedside gastric ultrasound technology; the assessment of dyspepsia scores was conducted with the assistance of another independent research nurse. Both of these researchers were blinded to the grouping of participants and the time elapsed from the consumption of the test meal to the assessment. Sample size calculation Based on the gastric emptying fraction as the primary outcome measure of this study, the sample size was estimated accordingly. Preliminary experimental results showed significant differences in gastric emptying rates at 90 minutes among the HV, CH, and PC groups (58%, 50%, and 39%, respectively). Given that this time point effectively reflects intergroup differences, the gastric emptying fraction at 90 minutes was selected for sample size calculation. With a significance level (α) of 0.05 and a power (1-β) of 90%, the sample size was estimated using PASS 11.0 software, yielding a required sample size of 28 participants per group. To account for potential sample loss and improve statistical accuracy, it was ultimately decided to enroll 100 patients in this study. Statistical analysis Statistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). The normality of continuous variables was assessed using the Shapiro-Wilk test. Normally distributed data are presented as mean ± standard deviation and were compared among groups using one-way analysis of variance (ANOVA), with post-hoc comparisons performed using Tukey's test. Non-normally distributed data are expressed as median (interquartile range) and were compared using the Kruskal-Wallis test, followed by Dunn's post-hoc test with Bonferroni correction. Categorical variables are reported as numbers (percentages) and were compared using the χ² test or Fisher's exact test, as appropriate. When the overall χ² test showed statistical significance, post-hoc pairwise comparisons were performed with Bonferroni adjustment of the significance level. All tests were two-tailed, and a P value of < 0.05 was considered statistically significant. Results General Characteristics of Three Groups From September 2022 to November 2022, a total of 100 subjects were screened. Among them, 10 participants were excluded for the following reasons: four for being outside the eligible age range (≥ 65 years); two for refusing to participate; two for a history of abdominal surgery; and two for diagnosed diabetes mellitus. Consequently, the final analysis included 90 participants (30 per group)(Fig. 2 ), exactly meeting our predetermined sample size requiremen. Table 1 presents the baseline characteristics of the study population. There were no statistically significant differences (P > 0.05) observed among the three groups in terms of age, gender ratio, body mass index (BMI), ASA physical status, fasting duration, and drinking prohibition duration. Compared to the HV group, the CH group and PC group showed a significant increase (P < 0.05) in dyspeptic symptom scores over the past three months. (Total screened: 100; Analyzed: n = 30 per group) Table 1 Baseline characteristics of healthy volunteers (HV), cholelithiasis (CH), and post-cholecystectomy (PC) groups. groups group HV(n = 30) group CH(n = 30) group PC(n = 30) F -value P -value Age (year,mean ± SD) 40 ± 12 44 ± 12 43 ± 10 2.43 0.513 Gender (M/F) 18/12 19/11 18/12 2.02 0.632 BMI (kg/m 2 ,mean ± SD) 23.5 ± 2.5 24.4 ± 2.7 23.9 ± 2.4 3.01 0.763 ASA physical status (I/II) 29/1 27/3 26/4 3.34 0.658 Fasting time for solids (hour,mean ± SD) 11.0 ± 0.3 10.9 ± 0.4 11.2 ± 0.2 3.11 0.587 Fasting time for clear liquids (hour,mean ± SD) 6.8 ± 0.2 7.6 ± 0.3 7.5 ± 0.3 4.52 0213 Dyspepsia score (points,mean ± SD) 3.6 ± 0.3 12.5 ± 1.2 12.7 ± 1.8 18.31 < 0.001 BMI Body mass index, ASA American Society of Anesthesiologists, SD Standard deviation P-value indicates the statistical difference between the three groups Comparison of cross-sectional area of the gastric antrum In each group, the subjects' gastric antrum cross-sectional area (CSA) reached its maximum value at 15 minutes after ingestion of the test meal. Subsequently, the CSA gradually decreased over time (15–120 minutes after test meal ingestion) (P < 0.05; Fig. 3 ). In comparison with the HV group, both the CH and PC groups exhibited an elevation in the cross-sectional area (CSA) at T3-7 (P < 0.05). Furthermore, when comparing the PC group to the CH group, an increase in CSA at T4-7 was observed (P 0.05; Table 2 ) *P < 0.05 vs. HV group, #P < 0.05 vs. CH group. Table 2 Gastric antrum cross-sectional area (CSA, cm²) at different time points after meal ingestion. groups group HV(n = 30) group CH(n = 30) group PC(n = 30) F -value P -value T 0 5.51 ± 0.19 5.52 ± 0.28 5.46 ± 0.23 0.53 0.183 T 1 13.78 ± 0.55 13.98 ± 0.70 13.69 ± 0.64 2.49 0.138 T 2 14.13 ± 0.32 14.02 ± 0.34 13.85 ± 0.41 2.87 < 0.001 T 3 9.64 ± 0.35 10.99 ± 0.89* 11.27 ± 0.67* 8.63 < 0.001 T 4 7.90 ± 0.43 9.69 ± 0.81* 10.15 ± 0.60* # 10.48 < 0.001 T 5 6.92 ± 0.39 8.26 ± 0.84* 9.56 ± 0.65* # 1.43 < 0.001 T 6 5.98 ± 0.24 6.92 ± 0.85* 8.34 ± 0.74* # 12.11 < 0.001 T 7 5.60 ± 0.22 6.22 ± 0.69* 7.49 ± 0.71* # 14.84 < 0.001 P-value indicates the statistical difference between the three groups *Indicates a statistically significant difference compared with group HV, P < 0.05 #Indicates a statistically significant difference compared with group CH, P < 0.05 Gastric emptying fractions at T5, T6, and T7 and gastric half-emptying time Compared with the healthy volunteer (HV) group, both the cholelithiasis (CH) group and the post-cholecystectomy (PC) group exhibited impaired gastric emptying, as evidenced by significantly lower gastric emptying fractions at T5, T6, and T7, along with a significantly prolonged gastric half-emptying time (P < 0.05). Further comparison revealed that gastric emptying delay was more severe in the PC group, with significantly lower gastric emptying fractions at T5, T6, and T7 and a longer gastric half-emptying time compared to the CH group (P < 0.05; Table 3 ). Table 3 Comparison of gastric emptying fraction, half-emptying time. groups group HV(n = 30) group CH(n = 30) group PC(n = 30) F -value P -value Gastric emptying fraction (%) T 5 49.01 ± 2.06 40.96 ± 4.88 * 29.85 ± 5.22 *# 12.28 < 0.001 T 6 55.92 ± 1.68 50.51 ± 5.70 * 38.89 ± 5.11 *# 9.52 < 0.001 T 7 60.32 ± 1.68 55.59 ± 4.71 * 46.23 ± 5.13 *# 90.12 < 0.001 Half-emptying time (min) 30.90 ± 2.24 44.70 ± 6.95 * 61.12 ± 11.42 *# 14.21 < 0.001 P-value indicates the statistical difference between the three groups *Indicates a statistically significant difference compared with group HV, P < 0.05 #Indicates a statistically significant difference compared with group CH, P < 0.05 Discussion This prospective observational study utilized serial ultrasonographic measurements of the cross-sectional area (CSA) of the gastric antrum to assess and compare gastric emptying following the ingestion of a semi-solid meal among healthy volunteers, patients with cholelithiasis, and post-cholecystectomy patients. The primary findings demonstrated that gastric emptying was significantly delayed in patients with cholelithiasis compared to healthy individuals, and this delay was further exacerbated following cholecystectomy. The methodological design of this study balanced assessment accuracy with clinical feasibility, employing ultrasound measurement of the gastric antral CSA as the core assessment technique. This method is non-invasive, radiation-free, operationally convenient, and provides real-time dynamic data. The measurement protocol was standardized by placing subjects in the right lateral decubitus position, thereby leveraging gravitational pooling of gastric contents to ensure consistent antral distension and reliable CSA measurements[32]. Multiple studies have confirmed a strong correlation between gastric antral CSA and intragastric food residue volume, demonstrating good reliability and validity[33-35]. To comprehensively evaluate gastric motor function, a multi-parameter strategy was adopted, incorporating: the gastric antral CSA, which reflects real-time gastric content volume; the gastric emptying fraction, which minimizes inter-individual variation through standardized calculation of emptying percentage; and the clinically recognized gastric half-emptying time, which reflects overall emptying efficiency. Regarding the selection of the test meal, this study employed yogurt rather than a carbohydrate solution as the standard meal, primarily based on its dual advantages in simulating physiological conditions and methodological reliability[27,28]. Unlike rapidly emptying carbohydrate liquids, the semi-solid characteristics of yogurt not only simulate the physiological gastric emptying pattern of a daily mixed meal but also, due to its content of fat and protein, effectively stimulate the neurohormonal regulatory mechanisms involved in gallbladder contraction and emptying. This is crucial for investigating the impact of biliary diseases on gastric motility. Furthermore, this physical consistency facilitates the acquisition of stable antral images under ultrasonography. Additionally, its nutritional composition is well-defined and consistent [protein 6.4g (8%), fat 7.2g (9%), carbohydrates 29.0g (36%)], with the total caloric content precisely controlled at 300 kcal. This energy level is sufficient to effectively stimulate gastric emptying without excessively prolonging the emptying time, thereby ensuring physiological relevance while maintaining standardized and reproducible experimental conditions. The observational endpoint was set at 120 minutes postprandially. This time point was chosen based on the physiology of semi-solid gastric emptying in healthy populations, aiming to adequately capture potential delays[36]. Our results confirm the validity of this design: it not only revealed delayed emptying in biliary disease patients but, crucially, because the delay in the PC group was progressive over time, a sufficiently long observation period was essential to quantify the additional impairment compared to the CH group. The dynamic changes in gastric emptying parameters in this study clearly demonstrate that, compared to healthy volunteers, patients in both the cholelithiasis (CH) and post-cholecystectomy (PC) groups exhibited delayed gastric emptying. This was characterized by a significant increase in the gastric antral cross-sectional area (CSA) during the middle to late postprandial phases (T3-T7), alongside a decreased gastric emptying fraction at T5, T6, and T7, and a prolonged gastric half-emptying time. It is noteworthy that although the objective gastric emptying parameters in the PC group were comprehensively worse than those in the CH group, there was no statistically significant difference in the subjectively reported dyspepsia symptom scores between the two groups. These data collectively indicate that biliary disease itself leads to delayed gastric emptying, and cholecystectomy, as its radical treatment, not only fails to improve this condition but rather exacerbates it further. This study also reveals that the severity of delayed gastric emptying does not exhibit a simple linear relationship with patients' subjective symptom perception.These objective data reveal the clear impact of biliary disease on gastric motility. To gain a deeper understanding of the underlying physiological mechanisms, it is necessary to analyze from the perspective of gallbladder function and bile excretion. Cholelithiasis impairs gastric emptying through closely related mechanisms of gallbladder function and bile excretion. The gallbladder is responsible for storing and concentrating bile. When stimulated by fatty chyme in the duodenum, it mediates the release of cholecystokinin (CCK). CCK promotes gallbladder contraction to facilitate fat digestion while simultaneously inhibiting gastric emptying to prolong the processing time of lipids in the intestine [37]. However, in patients with gallstones, mechanical obstruction or functional impairment of bile excretion leads to inefficient fat digestion. The undigested fat continuously stimulates the duodenum, resulting in excessive CCK secretion and sustained inhibition of gastric emptying [3, 38]. This mechanism is consistent with the delayed gastric emptying, prolonged half-emptying time, and increased residual gastric antral area observed in the gallstone group in this study, further supporting the adverse effects of gallstones on gastric motility. After cholecystectomy, alterations in the rhythm of bile secretion may lead to abnormalities in hormone secretion such as CCK and changes in bile flow patterns, thereby further inhibiting gastric motility[39-41]. Based on the above research findings, traditional fasting protocols may increase the risk of preoperative gastric fullness in patients with biliary tract diseases. The study by Chang et al. [6] also demonstrated that even among cholelithiasis patients who strictly adhered to traditional fasting guidelines, the incidence of gastric fullness was as high as 13%, which is significantly higher than that in other general surgery patients (approximately 5%), aligning with the perspective of this study. Therefore, within the Enhanced Recovery After Surgery (ERAS) pathway, preoperative fasting guidelines for patients with biliary tract diseases may require further refinement and optimization in the future to achieve more precise individualized management. It is recommended that, when conditions permit, patients with biliary tract diseases who have high-risk factors (such as gallbladder dyskinesia, comorbid diabetes, or a history of delayed gastric emptying symptoms) undergo rapid bedside gastric ultrasound assessment to objectively rule out gastric fullness. This approach would help ensure perioperative safety while further optimizing the implementation of the ERAS pathway. The potential impact of cholecystectomy on gastric emptying remains a subject of debate, with existing studies reporting inconsistent conclusions. For instance, Vignolo et al. [42]used the ¹³C-breath test to evaluate gastric emptying function in patients before and six months after surgery and found no significant changes. Similarly, in 2013, Bagaria et al. [4]employed radionuclide imaging to analyze gastric emptying in 25 patients before and two weeks after cholecystectomy and likewise concluded that the surgery had no significant effect. However, these findings differ from the results of the present study and those reported by Di Ciaula et al.[5], both of which indicated delayed gastric emptying postoperatively. Such discrepancies may stem from the combined influence of multiple methodological factors, including differences in the sensitivity of gastric emptying measurement techniques, timing of postoperative assessment, composition of test meals, and sample size. The ultrasonographic method used in this study not only offers the advantages of being real-time, dynamic, and radiation-free, but its assessment of gastric emptying via the cross-sectional area (CSA) of the gastric antrum has also been validated by several studies to correlate well with scintigraphy results, potentially making it more sensitive in detecting subtle changes during the emptying process. Furthermore, the relatively larger sample size in this study enhances the reliability and statistical power of the findings. Overall, the regulation of gastric emptying is complex and influenced by multiple factors, underscoring the need for further validation through high-quality, large-scale studies with long-term follow-up. This study has several limitations. First, only the cross-sectional areas (CSA) at different time points were measured, without corresponding gastric volume calculations. This was primarily due to the use of a semi-solid test meal and the current lack of an accurate model for such measurements, which may have introduced potential deviations in the results. Second, the patient population with cholelithiasis is inherently heterogeneous. Variations in gallstone size and the acute or chronic nature of cholecystitis may have introduced bias into the findings. Future studies should consider stratified analyses based on different subtypes of cholelithiasis. Third, the generalizability of our findings is limited by the strict inclusion and exclusion criteria. Specifically, patients with a high body mass index (BMI) or obesity, as well as those with diabetes mellitus, were excluded from this study. These populations are known to be at high risk for delayed gastric emptying, where gastric motility is influenced by additional pathophysiological factors such as insulin resistance and neuropathy. Consequently, our results are most applicable to non-obese, non-diabetic patients who meet the study criteria. Future research should specifically target these high-risk groups to investigate the impact of biliary diseases and cholecystectomy on gastric emptying, which would enable more precise and individualized clinical management strategies. Conclusion In summary, gastric emptying is significantly prolonged in patients with biliary disorders after ingestion of a semi-solid meal compared to healthy individuals. Furthermore, gastric emptying was significantly further delayed in post-cholecystectomy patients compared to those with unoperated cholelithiasis. Abbreviations ASA American Society of Anesthesiologists BMI Body mass index CSA cross-sectional area VAS Visual Analogue Scale Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the Northern Jiangsu People’s Hospital (:2022ky252) and registered prior to patient enrollment at Chinese Clinical Trial Registry (ChiCTR2200063900, on Sep 20 2022). Written informed consent was obtained from each recruited patient after providing them with adequate explanations regarding the aims of this study. The principles of Declaration of Helsinki were followed for this study. Consent for publication Not applicable. Competing interests The authors declare that they have no conflicts of interest regarding the content of this article. Author Contribution Xinna Lu, Wentao Lu, Yali Ge helped to design and to conduct the study. Yu Huang, Xiaowei Song, Keting Wu, Dejuan Shen, MeiYing Li,Shihan Zhao, Xinyan He helped to analyze the data and write the manuscript. All authors read and approved the final manuscript. Xinna Lu and Wentao Lu have contributed equally to this work and share first authorship. Acknowledgements The authors thank all the patients who participated in this study. We also thank all staff (Department of Anesthesiology, Subei People's Hospital of Jiangsu Province) for their help and support throughout the study. Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. References Littlefield A, Lenahan C. Cholelithiasis: Presentation and Management. J Midwifery Womens Health. 2019;64(3):289 − 97. Ibrarullah M, Mittal BR, Agarwal DK, Das BK, Kaushik SP. Gastric emptying in patients with gallstone disease with or without dyspepsia: effect of cholecystectomy. Aust N Z J Surg. 1994;64(4):247 − 50. 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Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Comparative Study. Obstetric Anesthesia Digest. 2023;43(1):1-. Freiberg B. Can an Abnormal Gastric Emptying Study Be Normal? J Nucl Med Technol. 2025;53(2):158 − 61. Zhang J, Qin J, Qin J, Zhao B, Zhang X, Wu J. The impact of preoperative carbohydrate ingestion one hour before surgery on children's preoperative anxiety and postoperative pain under ultrasound monitoring: A randomized controlled trial. J Clin Anesth. 2025;107:112031. Liu J, Li S, Li M, Li G, Huang N, Shu B, et al. Development and validation of machine learning predictive models for gastric volume based on ultrasonography: A multicentre study. J Clin Anesth. 2025;107:112010. Wang J, Yu X, Wang Y, Xu J, Wang Z, Zhang Y. Ultrasonic assessment of gastric solid contents in patients undergoing upper endoscope with sedation. BMC Anesthesiol. 2024;24(1):317. Sever F, Özmert S, Dereci S. The relationship between gastric ultrasound findings and endoscopically aspirated volume in infants and determining the antral cutoff value for empty stomach diagnosis. Paediatr Anaesth. 2024;34(6):532-7. Shi H, Wilde PJ, Yu H, Han J, Liu W. Food structure-mediated stomach-brain neural signaling controls gastric emptying. Crit Rev Food Sci Nutr. 2025:1–26. Liu W, Jin Y, Wilde PJ, Hou Y, Wang Y, Han J. Mechanisms, physiology, and recent research progress of gastric emptying. Crit Rev Food Sci Nutr. 2021;61(16):2742-55. Di Ciaula A, Portincasa P. Recent advances in understanding and managing cholesterol gallstones. F1000Res. 2018;7. Kennedy AL, Saccone GT, Mawe GM. Direct neuronal interactions between the duodenum and the sphincter of Oddi. Curr Gastroenterol Rep. 2000;2(2):104 − 11. McDonnell CO, Bailey I, Stumpf T, Walsh TN, Johnson CD. The effect of cholecystectomy on plasma cholecystokinin. Am J Gastroenterol. 2002;97(9):2189-92. Shabanzadeh DM. The Symptomatic Outcomes of Cholecystectomy for Gallstones. J Clin Med. 2023;12(5). Vignolo MC, Savassi-Rocha PR, Coelho LG, Soares MP, Cardoso-Júnior A, Barbosa TF, et al. Gastric emptying before and after cholecystectomy in patients with cholecystolithiasis. Hepatogastroenterology. 2008;55(84):850-4. Additional Declarations No competing interests reported. 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position.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8434062/v1/a739ab58fcace55454788be4.png"},{"id":100362175,"identity":"d3efebf5-1708-47c7-b388-0ab873dc4fc0","added_by":"auto","created_at":"2026-01-16 07:46:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":106135,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSTROBE flow diagram of participant enrollment, group assignment, and analysis.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8434062/v1/ea6d04adc0a5f530e7f783ba.png"},{"id":100013336,"identity":"40defe4f-d0fe-4ebb-b08d-72cbed8fbe85","added_by":"auto","created_at":"2026-01-12 06:19:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":103294,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDynamic changes in gastric antrum cross-sectional area (CSA, cm²) after a semi-solid meal in healthy volunteers (HV), cholelithiasis (CH), and post-cholecystectomy (PC) groups.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8434062/v1/eaf45b364e26152e8ab588b1.png"},{"id":100381017,"identity":"1c8a211e-67f2-4002-9fdd-95972f805da2","added_by":"auto","created_at":"2026-01-16 10:37:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1272454,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8434062/v1/1525f821-1572-4043-84e5-cecc7e5e7a7f.pdf"},{"id":100362418,"identity":"3750ac5e-5aeb-41e4-991c-841702f64c27","added_by":"auto","created_at":"2026-01-16 07:46:44","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":70899,"visible":true,"origin":"","legend":"","description":"","filename":"STROBE.doc","url":"https://assets-eu.researchsquare.com/files/rs-8434062/v1/7f474fdee3f2b472da5a485c.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ultrasonographic assessment of the effects of cholelithiasis and cholecystectomy on gastric emptying: a prospective observational cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003eCholelithiasis refers to the formation of stones in the gallbladder or biliary tract, which is a common condition of the digestive system. These stones are primarily composed of cholesterol, bile pigments, or mixed components, and may lead to biliary obstruction, inflammation, or infection[1]. Multiple studies have conclusively demonstrated that cholelithiasis induces delayed gastric emptying[2\u0026ndash;6]. The underlying mechanism may involve dysregulation of circulating gastric hormones and cholecystokinin due to impaired bile concentration, storage, and emptying functions, or alternatively, prolonged gastric emptying time mediated through complex neurohormonal pathways[5].\u003c/p\u003e \u003cp\u003eCholecystectomy remains the primary treatment for cholelithiasis[7]. In contrast to the well-established effects of gallstones on gastric emptying, post-cholecystectomy alterations in gastric motility continue to demonstrate inconsistent findings in clinical studies.Early studies generally suggested that cholecystectomy could improve gastric emptying function[2,3]. However, subsequent research has shown significant inconsistencies in findings. A 2013 prospective study by Dinesh Bagaria et al. demonstrated that cholecystectomy did not significantly affect gastric emptying time[4]. A more recent study has even found that post-cholecystectomy patients exhibited further deterioration in gastric emptying function compared to those with cholelithiasis[5]. Therefore, the impact of cholecystectomy on gastric motility requires further investigation.\u003c/p\u003e \u003cp\u003eDelayed gastric emptying holds significant clinical implications in the perioperative period. On one hand, it increases the risk of aspiration during anesthesia, with recent evidence suggesting that this risk may persist even when standard fasting protocols are followed[8]. On the other hand, postoperative delayed gastric emptying can prolong hospital stays, reduce quality of life, and increase economic burdens[9]. Since delayed gastric emptying is more common in individuals with underlying conditions such as diabetes and obesity, as well as those with a history of gastric surgery[10], clinical attention to changes in gastric emptying in patients with cholelithiasis and those undergoing cholecystectomy remains insufficient. Moreover, research on the impact of cholelithiasis and cholecystectomy on gastric emptying is relatively scarce.\u003c/p\u003e \u003cp\u003eMethods for measuring gastric emptying include scintigraphy, \u003csup\u003e13\u003c/sup\u003eC-urea breath test, ultrasonography, magnetic resonance imaging (MRI), wireless motility capsule, acetaminophen absorption test, electrogastrography (EGG), and electrical impedance tomography (EIT)[11]. Among these, scintigraphy has remained the gold standard due to its high accuracy[12]. However, this method presents several limitations including radiation exposure, high cost, and requirements for specialized equipment and facilities[13]. Ultrasonography has become an alternative to scintigraphy due to its advantages of being non-invasive, radiation-free, operationally convenient, cost-effective, capable of differentiating between liquid and solid emptying, and providing real-time dynamic assessment[14\u0026ndash;16]. Moreover, A study of 128 participants (92 healthy volunteers and 36 diabetic patients) found that ultrasound measurements strongly correlated with scintigraphy and showed no significant difference in accuracy compared to scintigraphy[17]. Ultrasonographic assessment of gastric emptying primarily involves measuring the cross-sectional area (CSA) of the antrum, as antral CSA exhibits a strong correlation with intragastric food residue volume[18,19]. This method provides an accurate estimation of gastric content volume, with its reliability and reproducibility well-documented in multiple studies[20\u0026ndash;22]. An additional advantage of antral CSA measurement lies in the consistent anatomical position and clearly defined boundaries of the antrum, facilitating precise localization[23].\u003c/p\u003e \u003cp\u003eCurrently, a series of studies on the effects of cholelithiasis on gastric motility suggest negative impacts, though the underlying mechanisms require further clarification. The influence of cholecystectomy on gastric emptying remains unclear. Ultrasonographic measurement of the antral cross-sectional area (CSA) enables accurate assessment of gastric emptying function. Therefore, we conducted a prospective controlled trial to evaluate the effects of cholelithiasis and cholecystectomy on gastric emptying using ultrasound, providing new evidence for clinical assessment of gastric emptying.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003e This prospective observational study was approved by the Ethics Committee of the Northern Jiangsu People's Hospital (2022ky252) and registered in the Chinese Clinical Trial Registry (ChiCTR2200063900). Written informed consent was obtained from all participants. A total of 100 subjects were recruited in this study from Northern Jiangsu People\u0026rsquo;s Hospital between September 2022 and November 2022, including the healthy volunteer (HV) group, cholelithiasis (CH) group, and post-cholecystectomy (PC) group. This work has been reported in line with observational studies (STROBE) guidelines [24] and the principles of the Declaration of Helsinki[25].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were as follows: (1) aged between 18\u0026ndash;64 years; (2) American Society of Anesthesiologists (ASA) physical status of I to II; (3) body mass index between 18\u0026ndash;30 kg/m\u003csup\u003e2\u003c/sup\u003e. The exclusion criteria were as follows: (1) suffering from cardiac, renal or hepatic dysfunction (2) severe metabolic, endocrine or electrolyte disorders (e.g., diabetes mellitus) (3) high risk of regurgitation and aspiration (e.g., achalasia of the cardia, pyloric obstruction, digestive obstruction, etc.); (4) history of gastrointestinal, hepatic and pancreatic diseases, and abdominal surgeries; (5) Cognitive or psychiatric impairment limiting cooperation; (6) Inability to assume the right lateral decubitus position; (7) lactose intolerance.\u003c/p\u003e\n\u003ch3\u003eStudy protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eStudy protocol\u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePre-enrollment preparation and fasting confirmation\u003c/h2\u003e \u003cp\u003eBefore enrollment, patients were tested to ensure they had not taken any medications that could affect gastrointestinal function for three days prior. We assessed all participants' dyspepsia scores over the past 3 months. Specific scores were based on the weekly frequency and severity of postprandial fullness and discomfort, early satiety, mid-upper abdominal pain, and mid-upper abdominal burning, up to a maximum of 36 points[26]. They were required to fast for at least 8 hours and abstain from drinking for 6 hours before consuming the test meal. The fasting state was confirmed by gastric ultrasonography, which showed the stomach in a flattened shape in the sagittal plane with the anterior and posterior walls close to each other, appearing as a \"target sign.\" In the coronal plane, it appeared as a \"ring sign\"[19].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSelection of the test meal\u003c/h3\u003e\n\u003cp\u003eParticipants were required to consume 250 g of yogurt within 5 minutes. The macronutrient composition consisted of 6.4 g of protein (accounting for 8% of total energy), 7.2 g of fat (9%), and 29.0 g of carbohydrate (36%), with a total energy content of 300 kcal. Yogurt was selected as the test meal in this study for the following reasons: (1) as a semi-solid meal, it balances physiological relevance and feasibility for ultrasound measurements[27]; (2) it offers good patient tolerance and high safety; (3) the 300 kcal energy content is sufficient to stimulate gastric emptying responses without excessively prolonging emptying time[28].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eUltrasonic localization\u003c/h2\u003e \u003cp\u003eGastric ultrasound examinations were performed on all patients using an ultrasound system equipped with a 2\u0026ndash;5 MHz curved array transducer (manufactured by Sonosite Ultrasonic Fujifilm Investment Co., LTD, China). The left lobe of the liver, pancreas, inferior vena cava, and superior mesenteric vein were used as anatomical landmarks for locating the gastric antrum in the sagittal plane of the epigastric region. The gastric antrum was identified immediately posterior to the left lobe of the liver and anterior to the pancreas, while the transducer was positioned along the sagittal plane of the epigastric region.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurement of CSA\u003c/h3\u003e\n\u003cp\u003eFor quantitative assessment, the patient was placed in the right lateral decubitus position at a 45\u0026deg; angle. A convex probe was positioned perpendicular to the longitudinal axis of the gastric antrum and tilted clockwise or counterclockwise to obtain the minimal circular cross-sectional view of the antrum. The cross-sectional area (CSA) of the gastric antrum was calculated using the ellipse area formula: CSA = (AP \u0026times; CC\u0026thinsp;\u0026times;\u0026thinsp;π)/4(AP\u0026thinsp;=\u0026thinsp;anteroposterior diameter and CC\u0026thinsp;=\u0026thinsp;cranio-caudal diameter) [29]. Diameters were measured from serosa to serosa during the gastric intercontractile phase. Three measurements were taken for each patient, and the average value was used for analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLandmarks: L, liver; P, pancreas; AP, anteroposterior diameter; CC, craniocaudal diameter.\u003c/p\u003e\n\u003ch3\u003eAssessment of gastric emptying\u003c/h3\u003e\n\u003cp\u003eThe following gastric emptying parameters were quantified ultrasonographically by the cross-sectional area (CSA) of the gastric antrum at baseline (T0) and at 5, 15, 30, 45, 60, 90, and 120 min after meal ingestion (T1 to T7): gastric emptying fractions at T5, T6, and T7, as well as the gastric half-emptying time. Gastric emptying score for a given period = [1 - (CSA for a given time period\u0026thinsp;\u0026divide;\u0026thinsp;15 min CSA)] \u0026times; 100 [30]. The gastric half-emptying time is defined as the time required for 50% of gastric contents to empty [31]; recording the gastric emptying fraction at T\u003csub\u003e7\u003c/sub\u003e. Gastric ultrasound measurements and interpretations were performed by the independent researcher proficient in bedside gastric ultrasound technology; the assessment of dyspepsia scores was conducted with the assistance of another independent research nurse. Both of these researchers were blinded to the grouping of participants and the time elapsed from the consumption of the test meal to the assessment.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSample size calculation\u003c/h2\u003e \u003cp\u003eBased on the gastric emptying fraction as the primary outcome measure of this study, the sample size was estimated accordingly. Preliminary experimental results showed significant differences in gastric emptying rates at 90 minutes among the HV, CH, and PC groups (58%, 50%, and 39%, respectively). Given that this time point effectively reflects intergroup differences, the gastric emptying fraction at 90 minutes was selected for sample size calculation. With a significance level (α) of 0.05 and a power (1-β) of 90%, the sample size was estimated using PASS 11.0 software, yielding a required sample size of 28 participants per group. To account for potential sample loss and improve statistical accuracy, it was ultimately decided to enroll 100 patients in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). The normality of continuous variables was assessed using the Shapiro-Wilk test. Normally distributed data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and were compared among groups using one-way analysis of variance (ANOVA), with post-hoc comparisons performed using Tukey's test. Non-normally distributed data are expressed as median (interquartile range) and were compared using the Kruskal-Wallis test, followed by Dunn's post-hoc test with Bonferroni correction. Categorical variables are reported as numbers (percentages) and were compared using the χ\u0026sup2; test or Fisher's exact test, as appropriate. When the overall χ\u0026sup2; test showed statistical significance, post-hoc pairwise comparisons were performed with Bonferroni adjustment of the significance level. All tests were two-tailed, and a P value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Characteristics of Three Groups\u003c/h2\u003e \u003cp\u003eFrom September 2022 to November 2022, a total of 100 subjects were screened. Among them, 10 participants were excluded for the following reasons: four for being outside the eligible age range (\u0026ge;\u0026thinsp;65 years); two for refusing to participate; two for a history of abdominal surgery; and two for diagnosed diabetes mellitus. Consequently, the final analysis included 90 participants (30 per group)(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), exactly meeting our predetermined sample size requiremen. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the baseline characteristics of the study population. There were no statistically significant differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) observed among the three groups in terms of age, gender ratio, body mass index (BMI), ASA physical status, fasting duration, and drinking prohibition duration. Compared to the HV group, the CH group and PC group showed a significant increase (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in dyspeptic symptom scores over the past three months.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e(Total screened: 100; Analyzed: n\u0026thinsp;=\u0026thinsp;30 per group)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of healthy volunteers (HV), cholelithiasis (CH), and post-cholecystectomy (PC) groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003egroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003egroup HV(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003egroup CH(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003egroup PC(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year,mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (M/F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e,mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA physical status (I/II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFasting time for solids (hour,mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFasting time for clear liquids (hour,mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspepsia score (points,mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBMI Body mass index, ASA American Society of Anesthesiologists, SD Standard deviation\u003c/p\u003e \u003cp\u003e \u003cp\u003eP-value indicates the statistical difference between the three groups\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComparison of cross-sectional area of the gastric antrum\u003c/h2\u003e \u003cp\u003eIn each group, the subjects' gastric antrum cross-sectional area (CSA) reached its maximum value at 15 minutes after ingestion of the test meal. Subsequently, the CSA gradually decreased over time (15\u0026ndash;120 minutes after test meal ingestion) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In comparison with the HV group, both the CH and PC groups exhibited an elevation in the cross-sectional area (CSA) at T3-7 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, when comparing the PC group to the CH group, an increase in CSA at T4-7 was observed (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There were no statistically significant differences in the cross - sectional area (CSA) among the three groups at T0\u0026ndash;2 (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. HV group, #P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. CH group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGastric antrum cross-sectional area (CSA, cm\u0026sup2;) at different time points after meal ingestion.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003egroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003egroup HV(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003egroup CH(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003egroup PC(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e0\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e5\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e6\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e8.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e7\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e7.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eP-value indicates the statistical difference between the three groups\u003c/p\u003e \u003cp\u003e*Indicates a statistically significant difference compared with group HV, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003e#Indicates a statistically significant difference compared with group CH, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eGastric emptying fractions at T5, T6, and T7 and gastric half-emptying time\u003c/h2\u003e \u003cp\u003eCompared with the healthy volunteer (HV) group, both the cholelithiasis (CH) group and the post-cholecystectomy (PC) group exhibited impaired gastric emptying, as evidenced by significantly lower gastric emptying fractions at T5, T6, and T7, along with a significantly prolonged gastric half-emptying time (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Further comparison revealed that gastric emptying delay was more severe in the PC group, with significantly lower gastric emptying fractions at T5, T6, and T7 and a longer gastric half-emptying time compared to the CH group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of gastric emptying fraction, half-emptying time.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003egroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003egroup HV(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003egroup CH(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003egroup PC(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastric emptying fraction (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e5\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e49.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29.85\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e6\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e55.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50.51\u0026thinsp;\u0026plusmn;\u0026thinsp;5.70\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e38.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003csub\u003e7\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e60.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e55.59\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e46.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.13\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHalf-emptying time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e30.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e44.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.95\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e61.12\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eP-value indicates the statistical difference between the three groups\u003c/p\u003e \u003cp\u003e*Indicates a statistically significant difference compared with group HV, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003e#Indicates a statistically significant difference compared with group CH, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective observational study utilized serial ultrasonographic measurements of the cross-sectional area (CSA) of the gastric antrum to assess and compare gastric emptying following the ingestion of a semi-solid meal among healthy volunteers, patients with cholelithiasis, and post-cholecystectomy patients. The primary findings demonstrated that gastric emptying was significantly delayed in patients with cholelithiasis compared to healthy individuals, and this delay was further exacerbated following cholecystectomy.\u003c/p\u003e\n\u003cp\u003eThe methodological design of this study balanced assessment accuracy with clinical feasibility, employing ultrasound measurement of the gastric antral CSA as the core assessment technique. This method is non-invasive, radiation-free, operationally convenient, and provides real-time dynamic data. The measurement protocol was standardized by placing subjects in the right lateral decubitus position, thereby leveraging gravitational pooling of gastric contents to ensure consistent antral distension and reliable CSA measurements[32]. Multiple studies have confirmed a strong correlation between gastric antral CSA and intragastric food residue volume, demonstrating good reliability and validity[33-35]. To comprehensively evaluate gastric motor function, a multi-parameter strategy was adopted, incorporating: the gastric antral CSA, which reflects real-time gastric content volume; the gastric emptying fraction, which minimizes inter-individual variation through standardized calculation of emptying percentage; and the clinically recognized gastric half-emptying time, which reflects overall emptying efficiency. Regarding the selection of the test meal, this study employed yogurt rather than a carbohydrate solution as the standard meal, primarily based on its dual advantages in simulating physiological conditions and methodological reliability[27,28]. Unlike rapidly emptying carbohydrate liquids, the semi-solid characteristics of yogurt not only simulate the physiological gastric emptying pattern of a daily mixed meal but also, due to its content of fat and protein, effectively stimulate the neurohormonal regulatory mechanisms involved in gallbladder contraction and emptying. This is crucial for investigating the impact of biliary diseases on gastric motility. Furthermore, this physical consistency facilitates the acquisition of stable antral images under ultrasonography. Additionally, its nutritional composition is well-defined and consistent [protein 6.4g (8%), fat 7.2g (9%), carbohydrates 29.0g (36%)], with the total caloric content precisely controlled at 300 kcal. This energy level is sufficient to effectively stimulate gastric emptying without excessively prolonging the emptying time, thereby ensuring physiological relevance while maintaining standardized and reproducible experimental conditions. The observational endpoint was set at 120 minutes postprandially. This time point was chosen based on the physiology of semi-solid gastric emptying in healthy populations, aiming to adequately capture potential delays[36]. Our results confirm the validity of this design: it not only revealed delayed emptying in biliary disease patients but, crucially, because the delay in the PC group was progressive over time, a sufficiently long observation period was essential to quantify the additional impairment compared to the CH group.\u003c/p\u003e\n\u003cp\u003eThe dynamic changes in gastric emptying parameters in this study clearly demonstrate that, compared to healthy volunteers, patients in both the cholelithiasis (CH) and post-cholecystectomy (PC) groups exhibited delayed gastric emptying. This was characterized by a significant increase in the gastric antral cross-sectional area (CSA) during the middle to late postprandial phases (T3-T7), alongside a decreased gastric emptying fraction at T5, T6, and T7, and a prolonged gastric half-emptying time. It is noteworthy that although the objective gastric emptying parameters in the PC group were comprehensively worse than those in the CH group, there was no statistically significant difference in the subjectively reported dyspepsia symptom scores between the two groups. These data collectively indicate that biliary disease itself leads to delayed gastric emptying, and cholecystectomy, as its radical treatment, not only fails to improve this condition but rather exacerbates it further. This study also reveals that the severity of delayed gastric emptying does not exhibit a simple linear relationship with patients' subjective symptom perception.These objective data reveal the clear impact of biliary disease on gastric motility. To gain a deeper understanding of the underlying physiological mechanisms, it is necessary to analyze from the perspective of gallbladder function and bile excretion. Cholelithiasis impairs gastric emptying through closely related mechanisms of gallbladder function and bile excretion. The gallbladder is responsible for storing and concentrating bile. When stimulated by fatty chyme in the duodenum, it mediates the release of cholecystokinin (CCK). CCK promotes gallbladder contraction to facilitate fat digestion while simultaneously inhibiting gastric emptying to prolong the processing time of lipids in the intestine [37]. However, in patients with gallstones, mechanical obstruction or functional impairment of bile excretion leads to inefficient fat digestion. The undigested fat continuously stimulates the duodenum, resulting in excessive CCK secretion and sustained inhibition of gastric emptying [3, 38]. This mechanism is consistent with the delayed gastric emptying, prolonged half-emptying time, and increased residual gastric antral area observed in the gallstone group in this study, further supporting the adverse effects of gallstones on gastric motility. After cholecystectomy, alterations in the rhythm of bile secretion may lead to abnormalities in hormone secretion such as CCK and changes in bile flow patterns, thereby further inhibiting gastric motility[39-41].\u003c/p\u003e\n\u003cp\u003eBased on the above research findings, traditional fasting protocols may increase the risk of preoperative gastric fullness in patients with biliary tract diseases. The study by Chang et al. [6] also demonstrated that even among cholelithiasis patients who strictly adhered to traditional fasting guidelines, the incidence of gastric fullness was as high as 13%, which is significantly higher than that in other general surgery patients (approximately 5%), aligning with the perspective of this study. Therefore, within the Enhanced Recovery After Surgery (ERAS) pathway, preoperative fasting guidelines for patients with biliary tract diseases may require further refinement and optimization in the future to achieve more precise individualized management. It is recommended that, when conditions permit, patients with biliary tract diseases who have high-risk factors (such as gallbladder dyskinesia, comorbid diabetes, or a history of delayed gastric emptying symptoms) undergo rapid bedside gastric ultrasound assessment to objectively rule out gastric fullness. This approach would help ensure perioperative safety while further optimizing the implementation of the ERAS pathway.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe potential impact of cholecystectomy on gastric emptying remains a subject of debate, with existing studies reporting inconsistent conclusions. For instance, Vignolo et al. [42]used the\u0026nbsp;¹³C-breath test to evaluate gastric emptying function in patients before and six months after surgery and found no significant changes. Similarly, in 2013, Bagaria et al. [4]employed radionuclide imaging to analyze gastric emptying in 25 patients before and two weeks after cholecystectomy and likewise concluded that the surgery had no significant effect. However, these findings differ from the results of the present study and those reported by Di Ciaula et al.[5], both of which indicated delayed gastric emptying postoperatively. Such discrepancies may stem from the combined influence of multiple methodological factors, including differences in the sensitivity of gastric emptying measurement techniques, timing of postoperative assessment, composition of test meals, and sample size. The ultrasonographic method used in this study not only offers the advantages of being real-time, dynamic, and radiation-free, but its assessment of gastric emptying via the cross-sectional area (CSA) of the gastric antrum has also been validated by several studies to correlate well with scintigraphy results, potentially making it more sensitive in detecting subtle changes during the emptying process. Furthermore, the relatively larger sample size in this study enhances the reliability and statistical power of the findings. Overall, the regulation of gastric emptying is complex and influenced by multiple factors, underscoring the need for further validation through high-quality, large-scale studies with long-term follow-up.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, only the cross-sectional areas (CSA) at different time points were measured, without corresponding gastric volume calculations. This was primarily due to the use of a semi-solid test meal and the current lack of an accurate model for such measurements, which may have introduced potential deviations in the results. Second, the patient population with cholelithiasis is inherently heterogeneous. Variations in gallstone size and the acute or chronic nature of cholecystitis may have introduced bias into the findings. Future studies should consider stratified analyses based on different subtypes of cholelithiasis. Third, the generalizability of our findings is limited by the strict inclusion and exclusion criteria. Specifically, patients with a high body mass index (BMI) or obesity, as well as those with diabetes mellitus, were excluded from this study. These populations are known to be at high risk for delayed gastric emptying, where gastric motility is influenced by additional pathophysiological factors such as insulin resistance and neuropathy. Consequently, our results are most applicable to non-obese, non-diabetic patients who meet the study criteria. Future research should specifically target these high-risk groups to investigate the impact of biliary diseases and cholecystectomy on gastric emptying, which would enable more precise and individualized clinical management strategies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, gastric emptying is significantly prolonged in patients with biliary disorders after ingestion of a semi-solid meal compared to healthy individuals. Furthermore, gastric emptying was significantly further delayed in post-cholecystectomy patients compared to those with unoperated cholelithiasis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASA American Society of Anesthesiologists\u003c/p\u003e\u003cp\u003eBMI Body mass index\u003c/p\u003e\u003cp\u003eCSA cross-sectional area\u003c/p\u003e\u003cp\u003eVAS Visual Analogue Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e The study was approved by the Ethics Committee of the Northern Jiangsu People’s Hospital (:2022ky252) and registered prior to patient enrollment at Chinese Clinical Trial Registry (ChiCTR2200063900, on Sep 20 2022). Written informed consent was obtained from each recruited patient after providing them with adequate explanations regarding the aims of this study. The principles of Declaration of Helsinki were followed for this study.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest regarding the content of this article.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXinna Lu, Wentao Lu, Yali Ge helped to design and to conduct the study. Yu Huang, Xiaowei Song, Keting Wu, Dejuan Shen, MeiYing Li,Shihan Zhao, Xinyan He helped to analyze the data and write the manuscript. All authors read and approved the final manuscript. Xinna Lu and Wentao Lu have contributed equally to this work and share first authorship.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank all the patients who participated in this study. We also thank all staff (Department of Anesthesiology, Subei People's Hospital of Jiangsu Province) for their help and support throughout the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Littlefield A, Lenahan C. Cholelithiasis: Presentation and Management. J Midwifery Womens Health. 2019;64(3):289\u0026thinsp;\u0026minus;\u0026thinsp;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Ibrarullah M, Mittal BR, Agarwal DK, Das BK, Kaushik SP. 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Crit Rev Food Sci Nutr. 2025:1\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Liu W, Jin Y, Wilde PJ, Hou Y, Wang Y, Han J. Mechanisms, physiology, and recent research progress of gastric emptying. Crit Rev Food Sci Nutr. 2021;61(16):2742-55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Di Ciaula A, Portincasa P. Recent advances in understanding and managing cholesterol gallstones. F1000Res. 2018;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Kennedy AL, Saccone GT, Mawe GM. Direct neuronal interactions between the duodenum and the sphincter of Oddi. Curr Gastroenterol Rep. 2000;2(2):104\u0026thinsp;\u0026minus;\u0026thinsp;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e McDonnell CO, Bailey I, Stumpf T, Walsh TN, Johnson CD. The effect of cholecystectomy on plasma cholecystokinin. Am J Gastroenterol. 2002;97(9):2189-92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Shabanzadeh DM. The Symptomatic Outcomes of Cholecystectomy for Gallstones. J Clin Med. 2023;12(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Vignolo MC, Savassi-Rocha PR, Coelho LG, Soares MP, Cardoso-J\u0026uacute;nior A, Barbosa TF, et al. Gastric emptying before and after cholecystectomy in patients with cholecystolithiasis. Hepatogastroenterology. 2008;55(84):850-4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cholelithiasis, Cholecystectomy, Gastric emptying, Healthy volunteers","lastPublishedDoi":"10.21203/rs.3.rs-8434062/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8434062/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCholelithiasis is a prevalent biliary tract disorder, and cholecystectomy serves as a primary treatment modality. However, the impact of cholelithiasis and cholecystectomy on gastric emptying remains unclear. Ultrasound is a user-friendly, non-invasive measurement tool. The study aims to assess the effects of cholelithiasis and cholecystectomy on gastric emptying by ultrasonically measuring the cross-sectional area (CSA) of the gastric antrum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients (n = 100) were divided into the cholelithiasis (CH) group, post-cholecystectomy (PC) group and healthy volunteer (HV) group (n = 30 each). The participants underwent an assessment of dyspepsia scores over the past nearly 3 months and drank a semi-solid test meal (300 kcal) after fasting. The following gastric emptying parameters were quantified ultrasonographically by the cross-sectional area (CSA) of the gastric antrum at baseline (T0) and at 5, 15, 30, 45, 60, 90, and 120 min after meal ingestion (T1 to T7): gastric emptying fractions at T5, T6, and T7, as well as the gastric half-emptying time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with the HV group, both the CH and PC groups showed a significant increase in CSA from T3 to T7 (P \u0026lt; 0.05), and the CSA of the PC group from T4 to T7 was larger compared with the CH group (P \u0026lt; 0.05). Compared with the HV group, both the CH and PC groups exhibited significantly higher dyspepsia scores and impaired gastric emptying, as evidenced by lower gastric emptying fractions at T5, T6, and T7, and a prolonged gastric half-emptying time (P \u0026lt; 0.05). There was no significant difference in the dyspepsia scores between the CH group and the PC group. However, compared with the CH group, the PC group exhibited significantly lower gastric emptying fractions at T5 T6, and T7, as well as a longer gastric half-emptying time (P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUltrasound assessment showed that compared with healthy volunteers, both patients with cholelithiasis and those after cholecystectomy had longer gastric emptying times, with the delay being more significant in the latter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewww.chictr.org.cn (20/09/2022 ChiCTR2200063900)\u003c/p\u003e","manuscriptTitle":"Ultrasonographic assessment of the effects of cholelithiasis and cholecystectomy on gastric emptying: a prospective observational cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 06:19:41","doi":"10.21203/rs.3.rs-8434062/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-30T11:52:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T08:26:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291803690532119058590044828303552508319","date":"2026-03-22T06:55:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222913673611466185579106085278276859283","date":"2026-03-17T07:23:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339355573356746108621284444150916394648","date":"2026-03-17T03:35:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-09T08:29:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93614482985160636091174650758756021639","date":"2026-01-07T22:48:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T15:09:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-07T15:03:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-03T04:02:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-02T13:08:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-01-02T12:57:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c80f292f-3faa-407e-8f99-3f34c216504f","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T12:08:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 06:19:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8434062","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8434062","identity":"rs-8434062","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}