{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:51:44Z","timestamp":1791525104685,"version":"4.3.4"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perioperative regurgitation of gastric or esophageal contents remains a severe complication during anesthesia. While standard fasting protocols and rapid sequence induction (RSI) are routinely employed, esophageal dilatation creates a hidden reservoir for retained food and secretions that conventional methods often fail to mitigate. Furthermore, standard gastric ultrasound lacks the field of view to detect mid-to-proximal esophageal pooling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present two parallel cases emphasizing this critical challenge. Case 1 involves a 68-year-old male with esophageal carcinoma who experienced massive regurgitation of white foam during RSI, despite five days of preoperative fasting. Airway security was ultimately achieved after intensified suctioning. Case 2 describes a 42-year-old female with achalasia and marked esophageal dilatation. Informed by preoperative computed tomography (CT) and barium swallow imaging, she was safely managed using targeted pre-anesthetic conscious endoscopic suctioning, leading to an uneventful induction and peroral endoscopic myotomy (POEM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These cases highlight the limitations of conventional fasting in managing proximal pooling. They underscore the diagnostic value of preoperative cross-sectional imaging, such as CT, when clinically indicated. Active pre-induction decompression, specifically through tailored endoscopic evacuation, is a valuable adjunctive strategy for preventing perioperative regurgitation in selected patients with megaesophagus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1933635","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:30:27Z","timestamp":1791523827000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Beyond the stomach: the role of preoperative imaging in assessing regurgitation risk in patients with esophageal dilatation: a report of two cases"],"prefix":"10.3389","volume":"13","author":[{"given":"Kecheng","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongpeng","family":"Pi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieyu","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/ALN.0000000000001452","article-title":"Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration","volume":"126","author":"Apfelbaum","year":"2017","journal-title":"Anesthesiology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1007\/s00455-023-10642-6","article-title":"Comprehensive assessment of esophageal disorders associated with hiatus hernia: insights from big data analysis","volume":"39","author":"Baker","year":"2024","journal-title":"Dysphagia"},{"key":"B3","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/j.alit.2019.03.003","article-title":"Eosinophilic gastrointestinal diseases - pathogenesis, diagnosis, and treatment","volume":"68","author":"Kinoshita","year":"2019","journal-title":"Allergol Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"419","DOI":"10.5056\/jnm23125","article-title":"Modern achalasia: diagnosis, classification, and treatment","volume":"29","author":"Pesce","year":"2023","journal-title":"J Neurogastroenterol Motil"},{"key":"B5","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.bjae.2022.09.001","article-title":"Rapid sequence induction and intubation","volume":"22","author":"Collins","year":"2022","journal-title":"BJA Educ"},{"key":"B6","doi-asserted-by":"publisher","first-page":"179","DOI":"10.5606\/tgkdc.dergisi.2024.25724","article-title":"Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: a retrospective study from three centers","volume":"32","author":"Topaloglu","year":"2024","journal-title":"Turk Gogus Kalp Damar Cerrahisi Derg"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1933635\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:30:28Z","timestamp":1791523828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1933635\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":6,"alternative-id":["10.3389\/fmed.2026.1933635"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1933635","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"1933635"}}