| Summary: | (1) Background: Acute muscle inflammation leads to increased sonographic echodensity. We developed a technique to characterize the echodensity of the gastric antrum wall and assess its feasibility in evaluating the severity of acute gastrointestinal injury (AGI); (2) Methods: The B-mode images of the gastric antrum of each enrolled patient were obtained daily by point-of-care ultrasound (POCUS). The 50th percentile, 85th percentile, and mean value of the grayscale distribution according to histogram analysis (ED<sub>50</sub>, ED<sub>85</sub>, and ED<sub>mean</sub>, respectively) were used to characterize the gastric antrum echodensity. Consistency and correlation analyses were performed to evaluate the feasibility and reproducibility of gastric antrum echodensity measurement. The association of gastric antrum echodensity with the severity of AGI and its ability to predict feeding intolerance (FI) were analyzed; (3) Results: In total, 206 POCUS images of 43 patients were analyzed. The gastric antrum echodensity measurements had sufficient intra- and inter-investigator reliabilities (intraclass correlation coefficient >0.9 for all parameters). The ED<sub>50</sub> showed a significant upward trend as AGI severity increased, as well as ED<sub>85</sub> and ED<sub>mean</sub> (<i>p</i> for trend <0.001, respectively). Patients who experienced FI had a higher ED<sub>50</sub> (67.8 vs. 56.1, <i>p</i> = 0.02), ED<sub>85</sub> (85.6 vs. 71.2, <i>p</i> = 0.01), and ED<sub>mean</sub> (70.3 vs. 57.6, <i>p</i> = 0.01) upon enteral feeding initiation; (4) Conclusions: Measurement of gastric antrum echodensity was technically feasible and reproducible in ventilated patients. Increased gastric antrum echodensity was associated with greater severity of AGI. Patients with higher gastric antrum echodensity upon enteral nutrition initiation via a nasogastric tube were more likely to develop FI.
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