Semaglutide users had six times higher rates of residual stomach content before procedures, but stopping the drug 14-21 days beforehand normalized the risk.
20.3% vs 3.2%Semaglutide users were over six times more likely to have increased residual gastric content compared to non-users undergoing endoscopy
What the researchers found
Semaglutide users had significantly higher rates of increased residual gastric content (20.3% vs 3.2%, p<0.001). Discontinuation >21 days in patients with digestive symptoms and >14 days in those without symptoms resulted in RGC comparable to non-users (OR 0.77, 95% CI 0.22-2.01).
Why it matters
Semaglutide and other GLP-1 receptor agonist peptides slow gastric emptying, which can leave food in the stomach during procedures requiring sedation — raising the risk of aspiration into the lungs. This study provides concrete timelines for when to stop the drug before surgery.
The numbers in context
Various perioperative semaglutide interruption intervals compared. Residual gastric content assessed by esophagogastroduodenoscopy.
How the study worked
Single-center retrospective chart review at a tertiary hospital. 1,094 patients undergoing esophagogastroduodenoscopy under deep sedation or general anesthesia (July 2021-July 2023) were divided into semaglutide (n=123) and non-semaglutide (n=971) groups. Increased RGC defined as any solid content or >0.8 mL/kg fluid. Univariate and multivariate logistic regression analyzed factors associated with increased RGC.
Who was studied
Semaglutide users and non-users undergoing endoscopy at a tertiary hospital
What this study cannot tell us
Retrospective single-center design limits generalizability. RGC measurement from suction canisters is imprecise compared to gastric ultrasound. Semaglutide group was relatively small (n=123). Different semaglutide doses and formulations were not separately analyzed. Results may not apply to other GLP-1 agonists with different half-lives.
How to read the evidence
Rated moderate: large sample (1,094 patients), clear statistical significance, and clinically actionable findings, but limited by retrospective single-center design and imprecise RGC measurement methods.
When this study was published
Published in 2024. Highly timely given the rapid increase in GLP-1 peptide prescriptions worldwide.
The bigger picture
As GLP-1 peptide drugs like semaglutide become widely prescribed for obesity and diabetes, perioperative safety becomes a population-level concern. This study helps anesthesiologists and surgeons develop evidence-based preoperative protocols for the millions of patients now taking these medications.
Questions still open
- Do other GLP-1 receptor agonist peptides like tirzepatide require similar or different discontinuation intervals?
- Could point-of-care gastric ultrasound replace fixed discontinuation timelines for personalized risk assessment?
- Are the aspiration risks different for oral vs injectable semaglutide formulations?
Common questions
How long should you stop semaglutide before surgery?
Does semaglutide increase surgery risks?
Read the original research
Effect of various perioperative semaglutide interruption intervals on residual gastric content assessed by esophagogastroduodenoscopy: A retrospective single center observational study.
Journal of clinical anesthesia, 99, 111668
Citation
Santos, Leonardo Barbosa; Mizubuti, Glenio B; da Silva, Leopoldo Muniz; Silveira, Saullo Queiroz; Nersessian, Rafael Souza Fava; Abib, Arthur de Campos Vieira; Bellicieri, Fernando Nardy; Lima, Helidea de Oliveira; Ho, Anthony M-H; Dos Anjos, Gabriel Silva; de Moura, Diogo Turiani Hourneaux; de Moura, Eduardo Guimarães Hourneuax; Vieira, Joaquim Edson. (2024). Effect of various perioperative semaglutide interruption intervals on residual gastric content assessed by esophagogastroduodenoscopy: A retrospective single center observational study.. Journal of clinical anesthesia, 99, 111668. https://doi.org/10.1016/j.jclinane.2024.111668