Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have increased in popularity in recent years due to their potent effect on glycaemia, adiposity and cardiovascular benefits in people living with type 2 diabetes (T2DM). There has also been an increase in off-label use for weight management in Australia. There have been recent updates from different American societies about the risk and optimisation of periprocedural gastroparesis with GLP-1 RA use.
We present three cases of retained gastric contents seen on gastroscopy. The first patient, a 62-year-old male (BMI 30 kg/m2), presented for routine follow up gastroscope for oesophagitis. He had commenced semaglutide 1mg the week prior to the procedure for weight management. Reported fasting time was 13 hours. Repeat gastroscopy 3 months later when semaglutide had been withheld for 3 weeks revealed an empty stomach after 12 hours of fasting. The second patient, a 61-year-old male (BMI 30 kg/m2), presented for elective gastroscopy for investigation of reflux. He had been using liraglutide daily injections for weight management. Reported fasting time was 10 hours. The final patient, a 55-year-old-female, presented for elective gastroscopy for investigation of iron deficiency. She had been taking semaglutide 0.5mg weekly for weight management. Reported fasting time was 14 hours.
These cases add to the growing literature of GLP-1 RA associated with increased retained gastric contents, with a case report of aspiration. GLP-1 RA delay gastric emptying, more prominently in short-acting formulation and with recent commencement. The American Society of Anesthesiologists recently recommended that GLP-1 RA be withheld for one dose prior to anaesthetic. However, it may be that a longer period of withholding, and/or prolonged fasting time are required, particularly if the GLP-1 RA was commenced recently. Further research, particularly in patients with T2DM incorporating glucose optimisation, is required to assess the perioperative risks of GLP-1 RA.