doi.org
Association between glucagon-like peptide-1 receptor agonists, residual gastric content, and bronchopulmonary aspiration after fasting: an ongoing systematic review and meta-analysis
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are being increasingly prescribed, raising concerns regarding delayed gastric emptying, residual gastric content (RGC), and bronchopulmonary aspiration risk despite standard fasting. This ongoing systematic review and meta-analysis evaluates the association between GLP-1 RA use, RGC, and aspiration across endoscopy and surgical populations. Systematic searches of Google Scholar identified 156 relevant publications. Studies assessing RGC or aspiration in fasted GLP-1 RA users were included, with data extracted for propensity-matched control groups where available. Meta-analyses were performed using random- and fixed-effects models, with heterogeneity and fragility analyses reported. GLP-1 RA use was consistently associated with higher RGC incidence. In upper gastrointestinal (UGI) endoscopy, pooled RGC incidence was 12.2% for UGI endoscopy alone and 4.1% with concomitant colonoscopy. In non-endoscopy populations, RGC incidence was markedly higher in GLP-1 RA users compared with controls (40.0% vs 15.0%). Although crude pooled data suggest a small increase in aspiration incidence in UGI endoscopy patients using GLP-1 RAs, random-effects meta-analyses showed no statistically or clinically meaningful association, and fragility analyses demonstrated limited robustness. Across surgical populations, no increase in aspiration risk was identified, though studies were underpowered due to the low baseline incidence of aspiration. These findings support a nuanced, context-specific approach to peri-procedural management of GLP-1 RAs and highlight the need for high-quality prospective studies to better define clinically meaningful risk.
