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 increasing being prescribed, raising concerns about their potential impact on gastric emptying and subsequent bronchopulmonary aspiration risk. This ongoing systematic review and meta-analysis assesses the association between GLP-1 RA use, residual gastric content (RGC), and aspiration events in fasting patients. A systematic literature search in Google Scholar identified 60 relevant studies. Inclusion criteria focused on studies evaluating RGC or aspiration incidence in fasted GLP-1 RA users. Studies employing indirect gastric emptying assessments, case reports, and non-English publications were excluded. Data extraction included control groups where available. Periodic literature search updates are planned. Among UGI endoscopy patients, the overall RGC incidence was 9.5% (886/9,343). Incidence varied by procedure type: 12.8% for UGI endoscopy alone, 4.3% with concomitant colonoscopy, and 9.3% for unspecified colonoscopy status. Control groups consistently showed lower RGC rates (2.1%). In non-endoscopy populations, RGC incidence was significantly higher at 50.5% (98/194) in GLP-1 RA users versus 8.5% in controls. Pooled aspiration incidence was 17.5 per 10,000 in the GLP-1 RA UGI endoscopy populations versus 13.6 in controls. surgical populations showing no significant increase in aspiration risk. Aspiration meta-analyses are likely to be underpowered. GLP-1 RAs are associated with increased RGC incidence, particularly in non-endoscopy populations, but aspiration risk remains unclear. Further research is required to refine fasting guidelines and perioperative management recommendations for GLP-1 RA users.