Ultrasound Can Check If Semaglutide Patients Are Safe for Surgery | Research

The takeaway

Preoperative stomach ultrasound identified 20% of semaglutide users with residual food despite fasting, with those taking the drug 1-3 days before surgery at highest risk.

20% had residual gastric contents
One in five semaglutide users still had food in their stomachs despite following standard preoperative fasting rules, with higher risk when the drug was taken 1-3 days before surgery.

What the researchers found

Among 25 patients who took weekly semaglutide less than 7 days before surgery:

- 20 patients (80%) had empty stomachs on ultrasound and proceeded without complications

- 5 patients (20%) had residual gastric contents despite adequate NPO (fasting) status and were rescheduled

- Semaglutide taken 1-3 days before surgery was significantly associated with residual gastric contents compared to 4-6 days before (p = 0.02)

- No postoperative aspiration complications occurred in patients who proceeded after clear ultrasound

Why it matters

With millions of people now taking GLP-1 drugs like semaglutide, anesthesiologists face a growing challenge: these drugs delay stomach emptying, meaning standard fasting guidelines may not ensure a safe empty stomach before surgery. This study provides a practical solution — bedside ultrasound — and identifies a timing threshold (4+ days before surgery) that may reduce aspiration risk while avoiding unnecessary surgical cancellations.

How the study worked

Prospective pilot study from July 2023 to February 2024. Patients who took their last weekly semaglutide dose less than 7 days before elective surgery underwent preoperative gastric point-of-care ultrasound. Those with empty stomachs proceeded; those with residual contents were rescheduled. Demographics, dosage, timing, fasting duration, and outcomes were recorded.

What this study cannot tell us

Very small sample size (n=25) limits the generalizability of findings. This was a single-center pilot study without a control group. Only semaglutide was studied; other GLP-1 drugs with different half-lives may have different timing profiles. The study cannot establish what NPO duration would be sufficient without ultrasound verification, and the 1-3 day vs 4-6 day threshold needs validation in larger cohorts.

How to read the evidence

This is a small prospective pilot study (n=25) from a single center. While it provides useful preliminary evidence, the sample size is too small for definitive conclusions and the findings need replication in larger multi-center studies.

When this study was published

Published in 2025 using data from 2023-2024, this addresses a very current clinical challenge as GLP-1 drug use continues to surge. Guidelines for perioperative GLP-1 management are still evolving.

The bigger picture

The explosion of GLP-1 peptide drug use is creating ripple effects across medicine. Anesthesiologists, surgeons, and perioperative teams are grappling with how to safely manage the millions of patients on these drugs who need surgery. This study contributes to the emerging body of evidence guiding preoperative GLP-1 drug management and demonstrates that ultrasound technology can bridge the gap between blanket drug-stopping rules and individualized patient assessment.

Questions still open

What is the optimal timing to stop semaglutide before surgery to ensure gastric emptying?
Should preoperative gastric ultrasound become standard for all GLP-1 drug users, regardless of timing?
Do other GLP-1 receptor agonists have different gastric emptying delay profiles requiring different preoperative management?

Common questions

Why is having food in your stomach dangerous during surgery?

When you're under anesthesia, your normal protective reflexes are suppressed. If there's food in your stomach, it can come back up and enter your lungs — a condition called pulmonary aspiration. This can cause severe lung damage, pneumonia, or even death. That's why patients are told to fast before surgery, but semaglutide can keep food in the stomach longer than expected.

Should I stop taking semaglutide before surgery?

Current guidelines are still evolving, but this study suggests that taking semaglutide within 1-3 days of surgery carries higher risk of retained food. Taking it 4-6 days before appears safer. However, always follow your surgeon's and anesthesiologist's specific instructions. This study also shows that a quick bedside ultrasound can confirm whether your stomach is empty, regardless of timing.

Read the original research

Role of Gastric Point-of-Care Ultrasound in Perioperative Management of Semaglutide.

Cureus, 17(6), e85791

View on PubMed ↗Publisher’s paper ↗

Citation

Muranaka, Mehana O; Nguyen, Tony H; Wang, Annie T; Cordero, Justin; Yang, Su-Jau; Felix, Jasmine; Nguyen, Jennifer L; Carré, Antoine L; Chu, Michael W. (2025). Role of Gastric Point-of-Care Ultrasound in Perioperative Management of Semaglutide.. Cureus, 17(6), e85791. https://doi.org/10.7759/cureus.85791