Relationship between perioperative semaglutide use and residual gastric content: A retrospective analysis of patients undergoing elective upper endoscopy.
Level 3 - non-randomized controlled study
Retrospective cohort study with a concurrent non-exposed comparison group and propensity weighting
PubMed 36870274 · doi:10.1016/j.jclinane.2023.111091
What was done
A single-center retrospective electronic chart review evaluated patients undergoing elective esophagogastroduodenoscopy (EGD) under deep sedation or general anesthesia between July 2021 and March 2022 at a tertiary hospital. Patients were categorized by whether they received semaglutide within 30 days prior to EGD (SG group) or not (NSG group). The primary outcome was increased residual gastric content (RGC), defined as any solid content or >0.8 mL/kg of fluid content measured from suction canisters. Risk was assessed using propensity-weighted analysis.
What was found
Of 886 performed EGDs, 404 patients were included (33 in the SG group, 371 in the NSG group). Increased RGC was detected in 8 of 33 (24.2%) patients taking semaglutide compared with 19 of 371 (5.1%) non-users (p < 0.001). In propensity-weighted analysis, semaglutide use was associated with increased RGC (estimate 5.15, 95% CI 1.92-12.92), as were preoperative digestive symptoms (3.56, 95% CI 2.2-5.78). Undergoing combined EGD and colonoscopy was associated with lower RGC risk (0.25, 95% CI 0.16-0.39). Among semaglutide users, mean interruption time did not differ between those with versus without increased RGC (10.5 ± 5.5 versus 10.2 ± 5.6 days, p = 0.54). Semaglutide was not associated with total volume of RGC (p = 0.99). One case of pulmonary aspiration occurred in the semaglutide group.
Why it matters
This study provides clinical evidence that GLP-1 receptor agonists can lead to retained gastric contents and potential aspiration risk during sedation, even after standard fasting periods.
Limits
The study is limited by its retrospective, single-center design and a small exposed cohort (33 semaglutide patients, with only 8 outcome events). Over half of screened procedures (482 of 886) were excluded from final analysis. Gastric volume estimation via suction canisters can be imprecise, and specific semaglutide dosing or indication-specific confounding were not detailed.
Cited by
- supports Patients on semaglutide undergoing general anesthesia have been found to retain food in their stomach despite fasting for 24 hours.