Introduction: Aspiration is associated with significant morbidity and mortality. Fasting guidelines do not apply to critically ill and emergency patients. Gastric point-of-care ultrasound (PoCUS) is a promising approach to assess aspiration risk. This review discusses its feasibility, clinical implications, limitations and future perspectives. Methods: This is a narrative review. A search in PubMed and EMBASE to find relevant articles was performed. Results: Gastric PoCUS provides both qualitative and quantitative information about gastric content and fluid volume. Based on qualitative findings, the antrum is empty or contains fluids or solids. Based on quantitative findings, a fluid volume of up to 500 ml is accurately measured. Gastric PoCUS is feasible in over 90% of subjects. An algorithm for clinical application is presented. Conclusion: Gastric PoCUS is a promising tool to assess gastric content and fluid volume in critical care and emergency patients. Further research on whether the information obtained improves patient outcome is needed. © 2019, Netherlands Society of Intensive Care. All rights reserved.