Residual gastric content and aspiration-related outcomes in perioperative patients treated with semaglutide: A systematic review and meta-analysis

Table 2 Characteristics of the included studies

Ref.	Country	Study type	Inclusion criteria	Exclusion criteria	Fasting	Procedure indication	Semaglutide interruption	Increased RGC definition	Anesthesia details	Extracted data source	NOS score
Santos et al[26], 2024	Brazil	Retrospective cohort	≥ 18 years-old, presenting for elective esophagogastroduodenoscopy	Gastric volvulus/frank outlet obstruction/active esophageal/gastric/duodenal bleeding, ASA physical status ≥ IV, recent (≤ 2 months) abdominal surgery, emergency procedures, EGD combined with surgical procedures, chronic renal/Liver disease, achalasia, Zenker’s diverticulum, linitis plastica, multiple myeloma, systemic collagenosis, amyloidosis, pregnancy, chronic opioid use, drug addiction, use of vasoactive agents, intensive care patients, preoperative use of medication that affect gastric emptying (tricyclic antidepressants, opioids, pro-kinetics, histamine H2- receptor antagonists) other than semaglutide, and incomplete medical records. Patients using GLP-1-Ras other than semaglutide and/or oral/daily semaglutide were also excluded	≥ 2 hours for clear fluids, ≥ 8 hours for solids and fluids with residue	General indications for EGD included dysphagia, odynophagia, persistent abdominal pain, intractable and/or chronic gastro-esophageal reflux	Preoperative interruption intervals were categorized based on its ~7-day half-life as ≤ 7 days, 8-14 days, 15-21 days, and > 21 days	Any amount of solid content from the esophagus to the pylorus, or > 0.8 mL/kg of fluid content (given its higher risk of bronchoaspiration) as measured from the aspiration/suction canister	Premedication was not routinely administered. The sedation/anesthetic procedure was at the discretion of the attending anesthesiologist and generally consisted of propofol titration to maintain spontaneous ventilation (under supplemental oxygen via nasal cannula), with occasional tracheal intubation. Intraoperative monitoring included sphygmomanometer, electrocardiography, pulse, and capnography	Main group	High
Phan et al[24], 2024	United States	Retrospective cohort	Patients on confirmed GLP1-Ras receiving an EGD between 2021 and 2023	NA	NA	NA	NA	NA	NA	Subgroup	High
Nersessian et al[2], 2024	Brazil	Retrospective cohort	All patients aged ≥ 18 years presenting for elective surgery between July and December 2023 at the Sao Luiz Hospital/Rede D’Or, Sao Paulo, Brazil	Type 2 diabetes; hiatal hernia; previous gastric surgery (gastrectomy, Roux-en-Y gastrojejunostomy, gastric band, fundoplication); ASA physical status ≥ 3; BMI > 40 kg/m2; recent (within 2 months) abdominal surgery; pre-operative semaglutide interruption interval > 10 days; chronic renal and/or liver disease; achalasia; Zenker’s diverticulum; linitis plastica; multiple myeloma; systemic lupus erythematosus and other collagenosis; pregnancy; chronic opioid use; drug addiction; pre-operative use of medication known to affect gastric emptying other than semaglutide (e.g., tricyclic antidepressants and opioids); and GLP-1 receptor agonists other than semaglutide	≥ 2 hours for clear fluids and ≥ 8 hours for solids and fluids with residue	NA	Patients were grouped according to time since their last dose of semaglutide, either within 1-7 days or 8-10 days	Any amount of solid content or > 1.5 mL/kg of clear fluids	NA	Main group	High
Gu et al[20], 2024	United States	Case-control	Adult patients on semaglutide who underwent an EGD between August 2022 and August 2023	Patients were excluded if they were in the intensive care unit at time of EGD, previously on GLP-1 agonist therapy, previously diagnosed with gastroparesis, or underwent EGD for acute gastrointestinal bleeding	NA	NA	NA	NA	NA	Main group	High
Zaffar et al[8], 2024	United States	Retrospective cohort	Of 2578 EGDs performed on adults (age 18-89 years) under deep sedation/general anesthesia between August 2022 and August 2023 were included in the study after simple random sampling	NA	NA	NA	NA	RGC found during EGD	Patients under deep sedation/general anesthesia	Subgroup	High
Silveira et al[10], 2023	Brazil	Retrospective cohort	All patients ≥ 18 years-old presenting for elective diagnostic upper endoscopy were eligible	Exclusion criteria were: Gastric outlet obstruction, gastric volvulus, frank/active esophageal/gastric/duodenal bleeding, ASA physical status ≥ IV, recent (≤ 2 months) abdominal surgery, emergency endoscopic procedures, urethral erosion combined with other/surgical procedures, chronic renal and/or liver disease, achalasia, Zenker’s diverticulum, linitis plastica, multiple myeloma, systemic collagenosis, amyloidosis, pregnancy, chronic opioid use, drug addiction, use of vasoactive agents, patients admitted to the intensive care unit, preoperative use/ingestion of medication known to affect gastric emptying (e.g., tricyclic antidepressants, opioids, pro-kinetics, histamine H2-receptor antagonists) other than semaglutide, and incomplete medical records. Patients using GLP-1 agonists other than semaglutide were also excluded	≥ 2 hours for clear fluids, and ≥ 8 hours for solids and fluids with residue	Elective diagnostic upper endoscopy	The time intervals of semaglutide interruption in patients with and without increased residual gastric content were 10 (6-15) and 11 (7.75-12.5) days, respectively (P = 0.67)	Any amount of solid content from the esophagus to the pylorus, or > 0.8 mL/kg of fluid content as measured from the aspiration/suction canister	The sedation/anesthetic procedure was at the discretion of the anesthesiologist	Main group	High
Korlipara et al[25], 2024	United States	Retrospective cohort	Adults undergoing EGD at Weill Cornell from January 2018 to March 2023, with or without semaglutide	NA	NA	NA	NA	Defined as “retained gastric contents” – no specific numeric threshold given	NA	Main group (author-provided)	High
Alkabbani et al[23], 2024	United States	Retrospective cohort	Patients using GLP-1 receptor agonists or SGLT-2 inhibitors undergoing upper endoscopy	Not clearly listed; based on claims data filters and diagnostic codes	NA	NA	NA	Implicitly assessed via diagnostic codes for aspiration and procedure discontinuation	NA	Subgroup	High
Welk et al[12], 2024	Canada	Retrospective cohort	Patients ≥ 66 years with type 2 diabetes who underwent elective surgery under general or spinal anesthesia between February 2020 and March 2023	Emergency surgery, multiple surgeries on the same day, incomplete or inconsistent data	Exclusion criteria included emergency surgery, multiple surgeries on the same day, and incomplete or inconsistent data	Various elective surgeries (e.g., joint replacement, cardiovascular, digestive, etc.)	None – patients were on active semaglutide therapy at the time of surgery	Not directly assessed – the outcome was postoperative pneumonia as an indirect marker of aspiration (RGC was neither visualized nor measured)	General anesthesia (58.6%) or spinal anesthesia (41.2%); data on type of induction, airway management, and medications were not included in the involved database	Main group	High
Ukwade et al[21], 2025	United States	Retrospective	EGD procedures performed between September 1, 2022, and October 30, 2023	Patients who were pregnant, incarcerated, under the age of 18, patients with a BMI > 50, and patients who were hospitalized. Patients were also excluded if they met the ASA physical status classification of ASA 4 (patients with severe systemic disease threatening life) or ASA 5	Midnight fast before EGD; morning medications allowed with small sips of water. Those who consumed any food are rescheduled as, per our institutional guidelines, since a fast of 8 hours is XXXrequire for any food other than clear liquids and a fast of 2 hours is XXXrequire for any clear liquids prior to an EGD	NA	NA	Defined as mentioning food or fluid in the endoscopy report, which was based on the endoscopist’s clinical judgment	NA	Subgroup	High
Vlaeminck et al[22], 2026	Belgium	Prospective cohort	Adult patients receiving semaglutide treatment – regardless of dose, administration route, frequency, or therapeutic indication - who were scheduled for elective surgery under general anesthesia	Patients were not included if they declined to participate; had a contraindication to gastric ultrasound (i.e., previous gastric surgery or hiatal hernia); comorbidities known to delay gastric emptying (scleroderma; systemic lupus erythematosus; hypothyroidism; Parkinson’s disease; cerebral palsy; and multiple sclerosis; or were unable to assume the right lateral decubitus position for sonography	European Society of Anaesthesia and Intensive Care fasting guidelines (i.e., > 2 hours for liquids and > 6 hours for solid foods)	NA	The ASA recommended GLP-1 RA withholding period (i.e., 1 week if administered weekly and 1 day if administered daily)	A patient was considered to have a “full stomach” or a “positive” gastric ultrasound if solid gastric content was visible in any position or if the calculated gastric volume in the right lateral decubitus position exceeded 1.5 mL/kg of total body weight	NA	Main group	High

ASA: American Society of Anesthesiologists; BMI: Body mass index; EGD: Esophagogastroduodenoscopy; GLP-1: Glucagon-like peptide 1; NOS: Newcastle-Ottawa Scale; NA: Not available; RGC: Residual gastric content; SGLT-2: Sodium glucose co-transporter 2.