Relationship between residual gastric content and peri‐operative semaglutide use assessed by gastric ultrasound: a prospective observational study

Summary Background Semaglutide is a long‐acting glucagon‐like peptide‐1 receptor agonist known to delay gastric emptying. Despite a growing body of evidence, its peri‐operative safety profile remains uncertain, particularly with regard to the risk of increased residual gastric content and aspiration of gastric contents during anaesthesia. We hypothesised that semaglutide interruption of ≤ 10 days before elective surgical procedures is insufficient to reduce or normalise the residual gastric content, despite fasting intervals that comply with current guidelines. Methods In this prospective observational study, we recruited patients who received pre‐operative once‐weekly subcutaneous semaglutide within 10 days of the procedure (semaglutide group) and control patients who had not been exposed to semaglutide (non‐semaglutide group). On the day of surgery, all patients underwent pre‐operative point‐of‐care gastric ultrasound to evaluate their residual gastric content. Increased residual gastric content was defined as any solid content or > 1.5 ml.kg ‐1 of clear fluids as assessed by gastric ultrasound. Results We recruited 220 patients, 107 in the semaglutide group and 113 in the non‐semaglutide group. Increased residual gastric content was found in 43/107 patients (40%) in the semaglutide group and 3/113 (3%) in the non‐semaglutide group (p < 0.001). In propensity‐weighted analysis, semaglutide use (OR 36.97, 95%CI 16.54–99.32), age (OR 0.95, 95%CI 0.93–0.98) and male sex (OR 2.28, 95%CI 1.29–4.06) were significantly associated with increased residual gastric content. There were no cases of pulmonary aspiration of gastric contents. Conclusion Pre‐operative semaglutide use within 10 days of elective surgical procedures was independently associated with increased risk of residual gastric content on pre‐operative gastric ultrasound assessment.