Association between glucagon-like peptide-1 receptor agonists, residual gastric content, and bronchopulmonary aspiration after fasting: an ongoing systematic review and meta-analysis

<p dir="ltr">Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly 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 113 relevant studies. Inclusion criteria focused on papers 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. Overall RGC incidence was 12.8% in UGI endoscopy-only patients and 4.3% with concomitant colonoscopy. Studies with control arms show a significantly higher incidence of RGC in patients on GLP-1 RAs for both procedures. In fasted non-endoscopy subjects, RGC incidence was significantly higher at 43.3% in GLP-1 RA users versus 6.3% in controls (p < 0.0001). Pooled aspiration incidence was significantly higher in the GLP-1 RA UGI endoscopy populations compared to controls (16.4 vs 14.1 in 10,000, p = 0.0373). Surgical populations show no significant increase in aspiration risk, with studies likely to be underpowered. GLP-1 RAs are associated with increased RGC incidence and aspiration risk in the UGI endoscopy population. In the non-endoscopy population, RGC incidence is significantly elevated but aspiration risk remains unclear.</p>