Perioperative GLP-1 RA use was associated with increased retained gastric contents but not with a consistent increase in clinically significant aspiration-related pulmonary complications.
Systematic Review
Does perioperative GLP-1 RA use increase aspiration-related pulmonary outcomes or retained gastric contents in adults undergoing procedures under anesthesia?
Perioperative GLP-1 RA use increases retained gastric contents but does not consistently increase clinically significant aspiration-related pulmonary complications, supporting an individualized perioperative management approach.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying and may increase residual gastric contents perioperatively, raising concern for pulmonary aspiration. The clinical significance of this pharmacologic effect remains uncertain across different procedural settings. We conducted a systematic review per PRISMA 2020 guidelines (PROSPERO: CRD420261334646). PubMed and the Cochrane Library were searched from inception through March 2026 for comparative studies evaluating perioperative GLP-1 RA use and aspiration-related or pulmonary outcomes in adults undergoing elective, urgent, or emergent procedures under anesthesia or procedural sedation. Risk of bias was assessed using ROBINS-I. A qualitative synthesis was performed given anticipated heterogeneity. Twenty comparative studies were included, encompassing endoscopic, elective surgical, and emergency surgical populations. No included study was at low overall risk of bias. Clinically significant aspiration-related pulmonary outcomes, such as aspiration pneumonitis, pneumonia, and respiratory failure, were not consistently elevated among GLP-1 RA users. In contrast, retained gastric contents and increased residual gastric volume were more consistently associated with GLP-1 RA exposure, particularly in endoscopic and ultrasound-based cohorts. Procedure-level consequences such as airway management modifications, delays, or abortion were reported but remained uncommon. Perioperative GLP-1 RA use is associated with increased retained gastric contents but not with a consistent increase in clinically significant aspiration-related pulmonary complications. The clinical impact appears variable and context-dependent, supporting an individualized approach with particular caution in higher-risk settings. Prospective studies with standardized outcome definitions are needed. • GLP-1 RA use was associated with increased retained gastric contents. • Aspiration-related pulmonary outcomes were uncommon across studies. • Pulmonary event rates were generally low despite heterogeneous definitions. • Procedure abortion or discontinuation was uncommon in absolute terms. • Findings support individualized perioperative GLP-1 RA management.
Adalier et al. (Fri,) conducted a systematic review in Patients receiving GLP-1 receptor agonists undergoing urgent and elective procedures. GLP-1 receptor agonists vs. No GLP-1 RA exposure was evaluated on Aspiration-related or pulmonary outcomes. Perioperative GLP-1 RA use was associated with increased retained gastric contents but not with a consistent increase in clinically significant aspiration-related pulmonary complications.