Beyond the antrum: troubleshooting pitfalls of gastric ultrasound

Gastric ultrasound is a well-established point-of-care ultrasound (PoCUS) application that aids clinicians in the assessment of gastric content and risk of aspiration at the bedside. In recent years, with the increasing use of Glucagon-like-Peptide 1 (GLP-1) receptor agonists the utility of gastric PoCUS has been endorsed by several professional societies, particularly when fasting status is uncertain. However, 2%-5% of gastric ultrasound exams can yield indeterminate findings due to various reasons. In this educational article, we aim to highlight common pitfalls that can lead to misinterpretation of gastric ultrasound findings and offer troubleshooting strategies to enhance image acquisition and interpretation. Finally, we suggest alternative scanning planes that may be considered when the standard approach is not feasible or fails to provide sufficient information.