Repositioning POCUS in the diagnostic landscape of gastric anisakiasis: A call toward pragmatic integration

Abstract

The recently published case report by Kitai et al. brings forward a timely and clinically impactful discussion on the role of point-of-care ultrasound (POCUS) in the early diagnosis of gastric anisakiasis¹—a parasitic disease whose clinical patterns and geographical distribution are being reshaped by global dietary trends and food distribution networks.^{2, 3}

The authors are to be commended for the clarity of their diagnostic approach. The combination of symptom chronology, dietary history, and real-time POCUS allowed for immediate endoscopic referral. The ultrasonographic finding of gastric wall thickening, though non-specific, provided critical support in narrowing down the differential diagnosis in a patient with acute epigastric pain.^{4, 5} This case not only illustrates the diagnostic agility of POCUS but also challenges conventional reliance on CT in early anisakiasis management.

While POCUS is more commonly applied to hepatobiliary or intestinal emergencies,⁴ its role in gastric parasitic infections remains underexplored. Previous reviews on intestinal anisakiasis have emphasized submucosal edema, ascites, and segmental ileal wall thickening as typical sonographic features.³ However, sonographic patterns specific to gastric anisakiasis remain largely anecdotal. The current report thus adds a valuable datapoint to the limited body of literature.

We propose two directions for expanding the utility of POCUS in this context. First, a multicentric image repository could aid in recognizing consistent gastric findings in anisakiasis—be it focal mucosal swelling, peristaltic arrest, or even visualization of the larval body, as sporadically reported in intestinal cases.³ Second, pretest probability stratification using clinical scoring systems (e.g., raw seafood consumption, timing of pain onset, absence of fever) could guide clinicians on when POCUS might be most effective or when CT should be prioritized.

Notably, the diagnostic success in this case was likely supported by the operator's advanced ultrasound experience (14 years). This emphasizes the need to include GI parasitology scenarios in emergency ultrasound training—a currently underrepresented domain. Embedding such cases in simulation-based curricula could build operator confidence in less common applications of POCUS.

In summary, this case invites emergency physicians and acute care teams to rethink the scope of POCUS—not merely as a triage tool, but as a frontline diagnostic modality for select gastrointestinal infections. Future efforts should aim at building evidence-based protocols for its judicious use in anisakiasis-endemic areas.

The authors declared that this study received no financial support.

The authors declare no competing interests.

Approval of the research protocol: NA.

Informed consent: NA.

Registry and the registration no. of the study/trial: NA.

Animal studies: NA.

The authors used a computational tool for language editing/checking in preparation of the article.