Perioperative Semaglutide Linked to Residual Gastric Content

Perioperative semaglutide use was associated with a higher risk of residual gastric content (RGC) and digestive symptoms, but evidence regarding pulmonary aspiration remains uncertain, according to a systematic review and meta-analysis published in the World Journal of Gastrointestinal Surgery.

Investigators from the University of Caxias do Sul in Brazil evaluated whether perioperative use of semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, was associated with RGC, the primary outcome, as well as pulmonary aspiration, digestive symptoms, procedure discontinuation, and gastroparesis compared with controls. Seven electronic databases were searched from inception through April 2026.

The analysis included 12 observational studies comprising 49,651 patients; no randomized trials were identified. RGC was reported in 14.1% of semaglutide users and 5.2% of controls (relative risk [RR], 3.49; 95% CI, 1.78-6.83; moderate certainty). Digestive symptoms occurred in 17.3% and 3.2% of controls, respectively (RR, 5.65; 95% CI, 3.61-8.84; moderate certainty).

Pulmonary aspiration was rare, occurring in 0.24% of semaglutide users and 0.37% of controls (RR, 1.46; 95% CI, 0.29-7.24; very low certainty). The pooled estimates for aspiration, procedure discontinuation, and gastroparesis were imprecise and not statistically significant, and the investigators reported that clinically important differences could not be excluded. They estimated that approximately 300,000 to 400,000 participants would be needed to detect a small absolute difference in aspiration risk.

The authors noted substantial heterogeneity for RGC (I², 87.8%), varying outcome definitions, and inconsistent reporting of semaglutide interruption intervals and fasting duration. They cautioned that RGC is a surrogate marker and that its increase should not be interpreted as direct evidence of increased aspiration risk. The authors called for prospective studies using standardized definitions, fasting protocols, and perioperative management strategies.

Source: Remus Ballotin V, Carneiro Ferreira PL, Tonin de Almeida V, et al. Residual gastric content and aspiration-related outcomes in perioperative patients treated with semaglutide: a systematic review and meta-analysis. World J Gastrointest Surg. 2026;18(9):121449. doi:10.4240/wjgs.121449