Journal Article

Ultrasound assessment of preoperative gastric volume in fasted diabetic surgical patients: A prospective observational cohort study on the effects of glucagon-like peptide-1 agonists on gastric emptying

Wolla, Christopher D., Wolf, Bethany J., Schorg, Lexi M., Wilson, Sylvia H., Pecha, Travis J., Sirianni, Joel M.

2025

Overview

Preoperative gastric ultrasound allows non-invasive qualitative and quantitative assessment of gastric contents aiding in preoperative risk assessment. We hypothesized that appropriately fasted diabetic surgical patients taking GLP-1 agonists would have higher gastric volumes than those not taking GLP-1 agonists. This prospective, observational cohort study enrolled diabetic patients undergoing elective surgery, comparing those taking (n = 106) and not taking (n = 100) GLP-1 agonists. The primary outcome was gastric volume assessed via gastric ultrasound in the right lateral decubitus position. Secondary outcomes included presence of a full stomach (solids/thick liquids or greater than 1.5 mL/kg clear liquid), need for surgery delay, Perlas grade, and occurrence of intraoperative aspiration. The impact of GLP-1 agonist type, duration of use, and timing of last dose on gastric volume was also examined. Diabetic patients on GLP-1 agonists had significantly higher median gastric volumes compared to patients not on GLP-1 agonists (0.61 mL/kg vs 0.16 mL/kg, P < 0.001) and increased odds of a full stomach (OR 11.3, 95 % CI 5.2–24.7, P < 0.0001). GLP-1 agonist use correlated with higher Perlas grades (P < 0.001). Gastric volumes were significantly higher with GLP-1 agonist use within 7 days of surgery relative to use within 7–14 days or more than 14 days from surgery (P < 0.001 for both comparisons). GLP-1 agonist therapy was associated with higher residual gastric volumes and higher risks of full stomachs in fasted diabetic patients. GLP-1 agonist use within 7 days of surgery was also associated with higher gastric volumes relative to holding therapy for over 7 days, supporting current consensus-based guidelines. •GLP-1 agonist therapy was associated with higher residual gastric volumes.•Higher gastric volumes seen with cessation of GLP-1 agonists within 7 days of surgery.•No difference in gastric volumes when holding GLP-1 agonists 7–14 days and > 14 days.•This opposes consensus-based guidelines on preoperative cessation of GLP-1 agonists.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Abdomen / Age / Aged / Agonists / Anesthesia / Body mass index / Diabetes / Elective surgery / Elective Surgical Procedures - adverse effects / Elective Surgical Procedures - methods / Ethnicity / Fasting / Female / Gastric Emptying - drug effects / Gastrointestinal Contents - diagnostic imaging / GLP-1 receptor agonists / Glucagon / Glucagon-Like Peptide 1 - agonists / Humans / Hypoglycemic Agents - adverse effects / Hypoglycemic Agents - pharmacology / Hypoglycemic Agents - therapeutic use / Informed consent / Kidney diseases / Male / Medical history / Middle Aged / Pain Medicine / Patients / Peptides / Perioperative care / Preoperative Care - methods / Prospective Studies / Stomach / Stomach - diagnostic imaging / Stomach - drug effects / Ultrasonic imaging / Ultrasonography - methods