Delayed gastric emptying, residual gastric content and procedural sedation
Does treatment with a glucagon-like peptide-1 receptor agonist increase residual gastric content at the time of elective procedural sedation?
§1Abstract
§1.1Review question
Does treatment with a glucagon-like peptide-1 receptor agonist increase residual gastric content at the time of elective procedural sedation?
§1.2PICO frame
Table 1. The registered PICO frame. Any change made after protocol registration is recorded in the amendment log at §5 and is identified there as post hoc.
| Element | As registered |
|---|---|
| Population | Adults presenting for elective endoscopy or surgery under sedation or general anaesthesia. |
| Intervention | Current treatment with a glucagon-like peptide-1 receptor agonist. |
| Comparator | No such treatment. |
| Outcomes | Residual gastric content on ultrasound or at endoscopy; pulmonary aspiration; procedure cancellation. |
§1.3Method in brief
A review of harms, in which the absence of an event in a trial of conventional size is treated as uninformative rather than as reassurance. The protocol was registered with the Institute's secretariat before the search was executed. The search was run on 18 July 2024 across 8 sources and is reproduced in full at §2. Screening, extraction and certainty assessment were performed independently by two members of the secretariat with disagreement resolved by a third.
§1.4Conclusion
Low certainty evidence, almost entirely observational, indicates that residual gastric content is found more often in treated patients after a standard fasting period. Pulmonary aspiration is rare enough that the observational evidence cannot establish whether the increase in residual content translates into an increase in aspiration. Professional guidance has changed on the basis of the residual-content finding, which the Institute records as a reasonable precautionary response to low certainty evidence and labels as such rather than presenting it as an evidence-based recommendation.
§1.5Limitations
§1.6Consultation
This review was released for public comment before ratification. Draft safety review: delayed gastric emptying and procedural sedation received 15 submissions. Amendments arising are recorded in the amendment log and are traceable to a numbered submission.