GLP-1 RA Cessation and Gastric Ultrasound Findings

Time-dependent Association Between Cessation of Glucagon-like Peptide-1 Receptor Agonists and Residual Gastric Contents Assessed by Point-of-care Gastric Ultrasound: a Prospective Observational Study

This prospective observational study will evaluate the association between the time interval since the last dose of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and residual gastric contents before elective surgery. Adult patients receiving GLP-1 RAs and scheduled for elective non-cardiac surgery under general anesthesia will undergo preoperative point-of-care gastric ultrasound. The study will assess whether longer GLP-1 RA cessation intervals are associated with lower ultrasound-estimated gastric volume and a lower frequency of high-risk gastric contents. Body mass index will also be evaluated as a potential modifier of this association.

Study Overview

• Status: Completed
• Conditions: Delayed Gastric Emptying; Residual Gastric Contents
• Intervention / Treatment: Other: GLP-1 RA Cessation Interval

Detailed Description

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for the treatment of type 2 diabetes and obesity. These agents can delay gastric emptying, raising concerns about residual gastric contents and potential aspiration risk during anesthesia. Current perioperative recommendations regarding GLP-1 RA discontinuation are largely consensus-based, and the physiological relationship between cessation interval and residual gastric content remains insufficiently defined.

This single-center prospective observational cohort study will enroll adult patients who are receiving GLP-1 RAs and are scheduled for elective non-cardiac surgery requiring general anesthesia. GLP-1 RA management will follow usual clinical care; the study team will not assign, modify, or instruct the timing of drug discontinuation. The primary exposure will be the number of days since the last GLP-1 RA dose, analyzed both as a continuous variable and according to prespecified cessation-interval categories.

Immediately before induction of anesthesia, participants will undergo standardized point-of-care gastric ultrasound. Qualitative gastric content will be assessed using the Perlas grading system, and quantitative gastric volume will be estimated from the antral cross-sectional area measured in the right lateral decubitus position. The primary outcome will be estimated gastric volume normalized to body weight. Secondary outcomes will include antral cross-sectional area, Perlas grade, and the presence of high-risk gastric contents.

Multivariable regression models will be used to evaluate the association between GLP-1 RA cessation interval and gastric ultrasound findings after adjustment for clinically relevant covariates, including age, sex, body mass index, diabetes status, preoperative fasting duration, and gastrointestinal symptom score. Body mass index will be evaluated as a prespecified effect modifier.

• Study Type: Observational
• Enrollment (Actual): 186

Contacts and Locations

Study Locations

• South Korea
  • Jeonbuk-do
    • Iksan, Jeonbuk-do, South Korea, 54538
      • Wonkwang University School of Medicine Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Adult patients receiving glucagon-like peptide-1 receptor agonists who are scheduled for elective non-cardiac surgery requiring general anesthesia at a tertiary academic hospital. Participants will be screened consecutively by the perioperative anesthesia team and enrolled if eligibility criteria are met.

Description

Inclusion Criteria:

• Adults aged 18 years or older.
• Patients receiving a glucagon-like peptide-1 receptor agonist.
• Patients scheduled for elective non-cardiac surgery requiring general anesthesia.
• Patients able to provide written informed consent.

Exclusion Criteria:

• Emergency surgery.
• History of prior gastric surgery.
• Known gastroparesis or severe gastroesophageal reflux disease.
• Declined or unable to provide written informed consent.

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Last GLP-1 RA Dose 3 Days or Less; Participants receiving glucagon-like peptide-1 receptor agonists whose last dose was taken 3 days or less before elective surgery. No intervention was assigned by the study protocol; GLP-1 RA management followed usual clinical care. Participants underwent preoperative point-of-care gastric ultrasound to assess residual gastric contents.	Other: GLP-1 RA Cessation Interval; Observed exposure defined as the number of days between the participant's last glucagon-like peptide-1 receptor agonist dose and elective surgery. Participants were categorized according to time since last dose: 3 days or less, 4 to 7 days, and 8 days or more. No GLP-1 receptor agonist was assigned, administered, continued, or discontinued by the study protocol; medication management followed usual clinical care.; Other Names: Time Since Last GLP-1 RA Dose; GLP-1 RA Discontinuation Interval
Last GLP-1 RA Dose 4 to 7 Days; Participants receiving glucagon-like peptide-1 receptor agonists whose last dose was taken 4 to 7 days before elective surgery. No intervention was assigned by the study protocol; GLP-1 RA management followed usual clinical care. Participants underwent preoperative point-of-care gastric ultrasound to assess residual gastric contents.	Other: GLP-1 RA Cessation Interval; Observed exposure defined as the number of days between the participant's last glucagon-like peptide-1 receptor agonist dose and elective surgery. Participants were categorized according to time since last dose: 3 days or less, 4 to 7 days, and 8 days or more. No GLP-1 receptor agonist was assigned, administered, continued, or discontinued by the study protocol; medication management followed usual clinical care.; Other Names: Time Since Last GLP-1 RA Dose; GLP-1 RA Discontinuation Interval
Last GLP-1 RA Dose 8 Days or More; Participants receiving glucagon-like peptide-1 receptor agonists whose last dose was taken 8 days or more before elective surgery. No intervention was assigned by the study protocol; GLP-1 RA management followed usual clinical care. Participants underwent preoperative point-of-care gastric ultrasound to assess residual gastric contents.	Other: GLP-1 RA Cessation Interval; Observed exposure defined as the number of days between the participant's last glucagon-like peptide-1 receptor agonist dose and elective surgery. Participants were categorized according to time since last dose: 3 days or less, 4 to 7 days, and 8 days or more. No GLP-1 receptor agonist was assigned, administered, continued, or discontinued by the study protocol; medication management followed usual clinical care.; Other Names: Time Since Last GLP-1 RA Dose; GLP-1 RA Discontinuation Interval

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Estimated Gastric Volume Normalized to Body Weight	Estimated gastric volume normalized to body weight, expressed as mL/kg, calculated from the antral cross-sectional area measured by preoperative point-of-care gastric ultrasound in the right lateral decubitus position.	Immediately before induction of anesthesia on the day of surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Antral Cross-Sectional Area	Antral cross-sectional area measured by preoperative point-of-care gastric ultrasound in the right lateral decubitus position and expressed in cm2.	Immediately before induction of anesthesia on the day of surgery
Perlas Gastric Ultrasound Grade	Qualitative gastric content assessed using the Perlas grading system. Grade 0 indicates an empty stomach, Grade 1 indicates fluid visible only in the right lateral decubitus position, and Grade 2 indicates fluid visible in both supine and right lateral decubitus positions.	Immediately before induction of anesthesia on the day of surgery
Gastrointestinal Symptom Score	Preoperative gastrointestinal symptom score assessing nausea, vomiting, bloating, early satiety, and abdominal discomfort.	Within 24 hours before surgery

Collaborators and Investigators

• Sponsor: Wonkwang University Hospital
• Investigators: Study Director: Cheol Lee, M.D.,Ph.D, Wonkwang University Hosptial

Study record dates

Study Major Dates

• Study Start (Actual): February 4, 2026
• Primary Completion (Actual): March 27, 2026
• Study Completion (Actual): May 20, 2026

Study Registration Dates

• First Submitted: May 28, 2026
• First Submitted That Met QC Criteria: May 28, 2026
• First Posted (Actual): June 3, 2026

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: May 28, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Digestive System Diseases; Gastrointestinal Diseases; Stomach Diseases; Paralysis; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Gastroparesis
• Other Study ID Numbers: Wonkwang UH25

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No