Quantified Metrics of Gastric Emptying Delay by Glucagon-Like Peptide-1 Agonists: A Systematic Review and Meta-Analysis With Insights for Periprocedural Management.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of controlled trials
PubMed 38634551 · doi:10.14309/ajg.0000000000002820
What was done
Systematic review and random-effects meta-analysis quantifying the magnitude of gastric emptying delay associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Outcomes were pooled as weighted mean differences with 95% confidence intervals across gastric emptying scintigraphy (mean T 1/2) and acetaminophen absorption tests (T max, AUC 4hr, AUC 5hr). Univariate meta-regression assessed the effects of drug type, short- vs long-acting formulation, and treatment duration.
What was found
Fifteen studies met inclusion criteria. Across 5 studies using scintigraphy (n = 247), mean T 1/2 was 138.4 minutes (95% CI 74.5–202.3) for GLP-1 RAs versus 95.0 minutes (95% CI 54.9–135.0) for placebo, yielding a pooled mean difference of 36.0 minutes (95% CI 17.0–55.0, P < 0.01, I² = 79.4%). Across 10 studies using acetaminophen absorption (n = 411), no significant delay occurred for T max, AUC 4hr, or AUC 5hr (P > 0.05). Meta-regression showed no significant effect of drug type, mechanism, or treatment duration (P > 0.05).
Why it matters
Provides objective quantification of GLP-1 RA-associated gastric delay (~36 minutes for solids and non-significant for liquids) to inform periprocedural fasting guidance and anesthesia risk assessment.
Limits
Scintigraphy analyses had high heterogeneity (I² = 79.4%), and total pooled sample size was modest (658 total participants). Clinical aspiration events and patient-level risk factors (e.g., baseline diabetic gastroparesis) were not measured in the abstract.
Cited by
- supports GLP-1 receptor agonists delay gastric emptying and slow intestinal peristalsis in humans.