Preoperative fasting status and retained gastric contents in patients undergoing endoscopy who are using glucagon-like peptide type 1 receptor agonists: a multicentre retrospective study.

PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for the management of type 2 diabetes mellitus and obesity. Nevertheless, their known effect of delaying gastric emptying raises perioperative concerns, particularly regarding the risk of pulmonary aspiration. There is limited evidence to guide fasting practices in this population. Our aim was to evaluate the association between preoperative fasting duration and the presence of retained gastric contents (RGC) in patients receiving GLP-1 RAs who underwent esophagogastroduodenoscopy (EGD). METHODS: We conducted a multicentre retrospective cohort study involving 337 patients from five Henry Ford Health System hospitals who underwent elective EGD between January 2018 and December 2023. Eligible patients were actively taking or had recently discontinued a GLP-1 RA within 90 days prior to the procedure. The primary outcome was the presence of RGC, defined as any small, moderate, or large amount of food or gastric material explicitly reported by the endoscopist in the EGD report. For regression analyses, fasting duration for solids was dichotomized at the cohort's median value (15 hr). We performed multivariable logistic regression to evaluate the association between preoperative fasting duration, the timing of GLP-1 RA suspension, and the presence of RGC, adjusting for clinically relevant covariates. RESULTS: The overall prevalence of RGC was 8.4%. In the adjusted model, fasting from solid foods for more than 15 hr was significantly associated with lower odds of RGC (adjusted odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13 to 0.81; P = 0.02). Fasting duration for liquids and presence of diabetes were not significantly associated with RGC. Suspension of GLP-1 RA within less than 7 days of the procedure related to RGC was not statistically significant (adjusted OR, 5.23; 95% CI, 0.67 to 39.38; P = 0.12). No significant association was observed between the duration of GLP-1 RA use and RGC prevalence. CONCLUSIONS: Patients with an active prescription for GLP-1 RA had lower odds of RGC during EGD after more than 15 hr fasting of solids.