Diabetes patients on GLP-1 receptor agonists were 11 times more likely to have food residue in their stomach during endoscopy (5.4% vs 0.49%), raising concerns about aspiration risk during procedures requiring sedation.
5.4% vs 0.49% gastric residueGLP-1RA users were 11 times more likely to have food remaining in their stomach despite standard fasting, potentially increasing aspiration risk during sedated procedures.
What the researchers found
In propensity score-matched analysis of 205 pairs of diabetes patients, the proportion with gastric residue during esophagogastroduodenoscopy was significantly higher in GLP-1RA users: 5.4% versus 0.49% in non-users (p=0.004) — approximately an 11-fold increase.
The 11 GLP-1RA patients with gastric residue were taking various agents: liraglutide 1.8 mg daily (n=2), dulaglutide 0.75 mg weekly (n=5), semaglutide 0.5 mg weekly (n=2), and semaglutide 1.0 mg weekly (n=2). This suggests the effect is a class-wide phenomenon across different GLP-1RAs and dosing frequencies.
Why it matters
As GLP-1 receptor agonist use skyrockets for diabetes and weight loss, more patients on these drugs will need endoscopy, surgery, and other procedures requiring fasting and sedation. The finding that standard fasting protocols may not adequately clear the stomach in GLP-1RA users has direct implications for patient safety — food aspiration during sedation can cause pneumonia or even death. This has led to updated preprocedural fasting guidelines.
How the study worked
Matched pair case-control study of 1,128 diabetes patients who underwent esophagogastroduodenoscopy at a single Japanese clinic from July 2020 to June 2022. One-to-one propensity score matching was performed between GLP-1RA users and non-users, controlling for age, sex, insulin treatment, and HbA1c. Gastric residue presence was compared using the McNemar test. 205 matched pairs were analyzed.
What this study cannot tell us
The study was conducted at a single Japanese clinic, which may limit generalizability. The overall number of patients with gastric residue was small (11 in the GLP-1RA group, 1 in controls), limiting subgroup analyses. The study could not assess whether the gastric residue caused any actual adverse events during procedures. Standard Japanese fasting protocols may differ from other countries. The study did not assess whether extending fasting times would eliminate the risk.
How to read the evidence
This is a propensity score-matched case-control study with a statistically significant finding. The matching methodology strengthens the comparison, but the small number of events (11 vs 1) and single-center design limit the evidence strength.
When this study was published
Published in 2023, this study was one of the earlier reports contributing to the revised preprocedural fasting guidelines for GLP-1RA users that have since been adopted by major anesthesiology societies.
The bigger picture
This study is part of a growing body of evidence that prompted anesthesiology societies worldwide to update their preprocedural fasting guidelines for patients taking GLP-1 receptor agonists. The American Society of Anesthesiologists now recommends considering holding GLP-1RAs before elective procedures. As these drugs become among the most prescribed medications globally, their interactions with standard medical procedures will continue to be a critical safety concern.
Questions still open
- Should GLP-1RA patients fast longer before procedures, and if so, how much longer is sufficient?
- Should GLP-1RAs be held before elective procedures requiring sedation, and how far in advance?
- Does the risk of gastric residue differ between daily and weekly GLP-1RA formulations?
Common questions
Should I stop my GLP-1 medication before medical procedures?
Why does food in the stomach during a procedure matter?
Read the original research
Association of glucagon-like peptide-1 receptor agonist treatment with gastric residue in an esophagogastroduodenoscopy.
Journal of diabetes investigation, 14(6), 767-773
Citation
Kobori, Toshiko; Onishi, Yukiko; Yoshida, Yoko; Tahara, Tazu; Kikuchi, Takako; Kubota, Tetsuya; Iwamoto, Masahiko; Sawada, Tomonobu; Kobayashi, Reo; Fujiwara, Hiroaki; Kasuga, Masato. (2023). Association of glucagon-like peptide-1 receptor agonist treatment with gastric residue in an esophagogastroduodenoscopy.. Journal of diabetes investigation, 14(6), 767-773. https://doi.org/10.1111/jdi.14005