Semaglutide Is an Independent Predictor of Retained Solid Gastric Contents, but Same-Day Colonoscopy Mitigates Effect

BACKGROUND AND AIMS

Glucagon-like peptide-1 receptor agonists are commonly prescribed for diabetes and obesity; however, their use may complicate anesthetized procedures due to delayed gastric emptying. This study sought to define rates of retained solid gastric contents, a risk factor for periprocedural complications, in a population taking semaglutide.

METHODS

This is a retrospective cohort study comparing individuals undergoing upper endoscopy over a 5-year period at a tertiary care center who were prescribed semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, for >4 weeks against a matched control cohort not on the medication. Multivariant logistic regression and multivariable propensity-matched association analysis were conducted to compare outcomes of interest, including retained solid gastric contents, endoscopic complications, and endoscopic outcomes.

RESULTS

In total, 1212 patients comprised the study population (602 on semaglutide, 610 not on semaglutide). On multivariant logistic regression analyzing causes of delayed gastric emptying, semaglutide was an independent risk factor for retained solid gastric contents (odds ratio [OR], 4.74; 95% CI, 2.40-9.35; P < 0.0001). On multivariable propensity-matched association analysis utilizing demographic and clinical characteristics, semaglutide use was associated with an absolute increase of 6% of retained solid gastric contents (coefficient, 0.0644; 95% CI, 0.034-0.095; P < 0.0001). Same-day colonoscopy was protective against this finding (OR, 0.41; 95% CI, 0.23-0.73; P = 0.003). Intubation was rare and not associated with semaglutide use (OR, 0.70; 95% CI, 0.30-1.64; P = 0.41). No periprocedural aspiration events occurred.

CONCLUSION

Semaglutide was an independent risk factor for retained solid gastric contents, even when accounting for confounding factors. This was negated in patients undergoing same-day colonoscopy, indicating an opportunity for preprocedural fasting protocols in the absence of medication hold.