GLP-1 agonist therapy was associated with a 5.8-fold increased odds of residual gastric contents in fasting patients undergoing endoscopy, with 19% showing visible food versus 5% in controls.
5.8× higher odds of retained foodGLP-1 drug users had nearly 6 times the risk of having visible gastric contents despite standard fasting before endoscopy
What the researchers found
GLP-1 agonist therapy was associated with an adjusted odds ratio of 5.8 (95% CI 1.7-19.3, p=0.004) for residual gastric contents in fasting patients, with 19% of GLP-1 users showing visible food at endoscopy versus 5% of controls.
Why it matters
With millions of people now taking GLP-1 drugs, this is a critical safety signal for anesthesia and procedural medicine. Retained gastric contents during sedation can lead to aspiration pneumonia — a potentially fatal complication. Patients and providers need to be aware that standard fasting guidelines may not be sufficient for GLP-1 drug users.
The numbers in context
90 procedures in GLP-1 users compared to matched controls. Study period: 2019-2023.
How the study worked
Historical cohort study reviewing EGD records (2019-2023). 90 procedures in patients on GLP-1 agonists (GLP group) compared to 102 procedures in patients who started GLP-1 therapy within 1,000 days after their EGD (control). Excluded: emergent procedures, combined EGD/colonoscopy, known gastroparesis, previous gastric surgery. Confounder-adjusted generalized linear mixed effect model.
Who was studied
Patients undergoing EGD, comparing GLP-1 RA users to non-users
What this study cannot tell us
Retrospective design with relatively small sample sizes. The control group (future GLP-1 users) may differ from the GLP group in ways that affect gastric emptying. Documentation of gastric contents may vary by endoscopist. The fasting duration was comparable but specific timing of last GLP-1 dose was not captured. The study cannot establish how long before a procedure GLP-1 drugs should be held.
How to read the evidence
Moderate evidence from a well-designed historical cohort study. Small sample size limits precision, but the effect size is large and clinically significant. Findings align with known GLP-1 pharmacology.
When this study was published
Published in 2024, addressing a timely safety concern as GLP-1 drug prescriptions grow rapidly worldwide.
The bigger picture
This study adds to growing evidence that GLP-1 drugs significantly delay gastric emptying — a feature that helps with appetite suppression but creates procedural risks. The American Society of Anesthesiologists has already updated guidelines to recommend holding GLP-1 drugs before elective procedures, but practice varies widely. As GLP-1 prescriptions explode, standardized pre-procedural protocols are urgently needed.
Questions still open
- How many days before an elective procedure should GLP-1 drugs be held to normalize gastric emptying?
- Should GLP-1 drug users undergo additional pre-procedural assessment (like point-of-care gastric ultrasound) before sedation?
- Does the risk differ between weekly (semaglutide) and daily (liraglutide) GLP-1 formulations?
Common questions
Should I stop my GLP-1 drug before a medical procedure?
Why is retained stomach food during sedation dangerous?
Read the original research
Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 71(7), 958-966
Citation
Wu, Fei; Smith, Matthew R; Mueller, Ariel L; Klapman, Seth A; Everett, Lucinda L; Houle, Timothy; Kuo, Braden; Hobai, Ion A. (2024). Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study.. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 71(7), 958-966. https://doi.org/10.1007/s12630-024-02719-z