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Purpose <p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, potentially increasing aspiration risk during anesthesia or sedation. Guidelines for withholding these agents before procedures remain inconsistent. This study prospectively evaluated whether prolonged fasting or time since the last GLP-1 RA dose more effectively predicts reduced solid gastric content and other indicators of aspiration risk.</p> Methods <p>This prospective observational study enrolled 134 adults (74 GLP-1 RA users, 60 controls) from an internal medicine clinic, fasting 8–16&#xa0;h. Point-of-care ultrasound (POCUS) was used to assess gastric antral content, cross-sectional area, and gastric volume (GV). Analyses included subgroup comparisons and multivariable regression adjusting for fasting duration, GLP-1 dose, and timing.</p> Results <p>Solid gastric content was similar between GLP-1 users (4/74, 5.4%) and controls (3/60, 5.0%) (p = 0.563). Mean fasting duration was 13.0 ± 2.4&#xa0;h. Among GLP-1 users, those with solids had shorter fasting times than those without (10.88 ± 0.75 vs. 13.14 ± 2.40&#xa0;h; Welch’s t-test p = 0.022, permutation p = 0.0684). Longer fasting trended toward lower odds of solids (OR = 0.61, p = 0.075). Fasting duration demonstrated a stronger inverse association with GV (β = −&#xa0;2.26&#xa0;mL/h) than time since last GLP-1 dose, which was not significant.</p> Conclusions <p>Fasting duration, rather than time since last GLP-1 dose, was more closely associated with reduced gastric content and volume. These findings support individualized fasting strategies and POCUS-based assessment over routine medication withholding for perioperative safety.</p>

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Fasting Duration, Not Timing of Last GLP-1 Dose, Predicts Aspiration Risk Indicators: A Prospective Point-of-Care Gastric Ultrasound Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月21日

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  • Enayat Shahidifar,
  • Marlena Lesniowska,
  • Ester Deschenes,
  • Gregory Polcha,
  • Carl Manzo,
  • Timothy Barreiro,
  • Ghazaleh Bigdeli,
  • Arman Hemmat,
  • Patrick Brine,
  • Alexander Malik,
  • Gengqing Song

摘要

Purpose

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, potentially increasing aspiration risk during anesthesia or sedation. Guidelines for withholding these agents before procedures remain inconsistent. This study prospectively evaluated whether prolonged fasting or time since the last GLP-1 RA dose more effectively predicts reduced solid gastric content and other indicators of aspiration risk.

Methods

This prospective observational study enrolled 134 adults (74 GLP-1 RA users, 60 controls) from an internal medicine clinic, fasting 8–16 h. Point-of-care ultrasound (POCUS) was used to assess gastric antral content, cross-sectional area, and gastric volume (GV). Analyses included subgroup comparisons and multivariable regression adjusting for fasting duration, GLP-1 dose, and timing.

Results

Solid gastric content was similar between GLP-1 users (4/74, 5.4%) and controls (3/60, 5.0%) (p = 0.563). Mean fasting duration was 13.0 ± 2.4 h. Among GLP-1 users, those with solids had shorter fasting times than those without (10.88 ± 0.75 vs. 13.14 ± 2.40 h; Welch’s t-test p = 0.022, permutation p = 0.0684). Longer fasting trended toward lower odds of solids (OR = 0.61, p = 0.075). Fasting duration demonstrated a stronger inverse association with GV (β = − 2.26 mL/h) than time since last GLP-1 dose, which was not significant.

Conclusions

Fasting duration, rather than time since last GLP-1 dose, was more closely associated with reduced gastric content and volume. These findings support individualized fasting strategies and POCUS-based assessment over routine medication withholding for perioperative safety.