GLP-1 receptor agonists could modestly delay gastric emptying during periprocedural fasting, study suggests

Glucagon-like peptide-1 (GLP-1) receptor agonists are associated with a delay in gastric emptying of solid food that is within periprocedural fasting periods, a recent study found.

Researchers performed a systematic review and meta-analysis of studies published between 2003 and 2023 to evaluate gastric emptying in relation to periprocedural management of GLP-1 receptor agonist therapy. Studies on oral GLP-1 receptor agonists that quantified gastric emptying with scintigraphic measurement, stable isotope breath testing, acetaminophen-based absorption testing (AAT), or wireless motility capsule were included. Univariate meta-regression was performed to assess the effects of GLP-1 receptor agonist type, short- versus long-acting mechanism, and treatment duration. The results were published April 18 by the American Journal of Gastroenterology.

Fifteen studies met the inclusion criteria, five with a total of 247 patients that measured gastric emptying with scintigraphy and 10 with 411 patients that used AAT. The mean time required to empty 50% of ingested gastric contents was 138.4 minutes (95% CI, 74.5 to 202.3 minutes) with GLP-1 receptor agonists versus 95.0 minutes (95% CI, 54.9 to 135.0 minutes) with placebo (pooled mean difference, 36.0 minutes [95% CI, 17.0 to 55.0 minutes]; P<0.01). In the AAT studies, no significant delay in gastric emptying was seen with GLP-1 receptor agonists as measured by time elapsed until reaching peak level of isotope exhalation on breath testing or acetaminophen blood concentration, area under the curve at four hours, or area under the curve at five hours (P>0.05). Type of GLP-1 receptor agonist, mechanism of action, and treatment duration appeared to have no effect on gastric emptying (P>0.05).

The researchers noted that stratification of patients by indication for GLP-1 receptor agonist was not possible, among other limitations. They concluded that their study indicated mild gastric emptying delay with GLP-1 receptor agonists on scintigraphy and no significant difference from placebo on measures of liquid emptying.

"Our findings do not support withholding GLP-1 RA [receptor agonist] agents in patients anticipated to remain on a liquid diet prior to procedure. While our results demonstrated modest delays relative to the 8 hour pre-procedural fasting periods on solid phase testing, more studies quantifying gastric retention on scintigraphy at 4 hours are needed," they wrote. "Based on current evidence, a conservative approach with liquid diet on the day prior to procedures while continuing GLP-1 RA therapy would represent the most sensible approach until more conclusive data on solid diet is available."