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World J Gastrointest Surg. Sep 27, 2026; 18(9): 121449
Published online Sep 27, 2026. doi: 10.4240/wjgs.121449
Residual gastric content and aspiration-related outcomes in perioperative patients treated with semaglutide: A systematic review and meta-analysis
Vinicius Remus Ballotin, Pedro Lucas Carneiro Ferreira, Valentina Tonin de Almeida, Carolina da Silva Borges, Henrique Tonin de Almeida, Rodrigo Giovanardi Pandolfo da Silva, Daniel Volquind, Luciano da Silva Selistre
Vinicius Remus Ballotin, Department of Health Sciences, University of Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
Pedro Lucas Carneiro Ferreira, Valentina Tonin de Almeida, Carolina da Silva Borges, Henrique Tonin de Almeida, Rodrigo Giovanardi Pandolfo da Silva, School of Medicine, University of Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
Daniel Volquind, Department of Anesthesia and Pain Medicine, University of Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
Luciano da Silva Selistre, Department of Nephrology and Biostatistics, University of Caxias do Sul, Caxias do Sul, Brazil, University of Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
Co-first authors: Vinicius Remus Ballotin and Pedro Lucas Carneiro Ferreira.
Author contributions: Remus Ballotin V and Carneiro Ferreira PL performed the literature search, study screening, and data extraction; they both contributed equally to this article and are the co-first authors of this manuscript; Vinicius RB and Luciano SS conducted the statistical analyses and drafted the manuscript; da Silva Borges C and Tonin de Almeida H assisted with study selection, data verification, and evidence quality assessment; da Silva Borges C, Tonin de Almeida H, and Giovanardi Pandolfo da Silva R supported data extraction, tabulation, and figure preparation; Remus Ballotin V, Volquind D, and da Silva Selistre L conceptualized and designed the study; Volquind D, and da Silva Selistre L supervised the methodology, contributed to data interpretation, and critically revised the manuscript; and all authors read and approved the final version of the manuscript.
AI contribution statement: All the contents of the document responding to the review comments were written by humans. ChatGPT is only used for language polishing and grammar correction.
Supported by Graduate Support Program for Community Higher Education Institutions Scholarship, granted by the Brazilian Government Agency Coordination for the Improvement of Higher Education Personnel.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Vinicius Remus Ballotin, MD, Principal Investigator, Researcher, Department of Health Sciences, University of Caxias do Sul, Campus-Sede Rua Francisco Getúlio Vargas, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil.
vrballotin@ucs.br
Received: March 25, 2026
Revised: April 23, 2026
Accepted: June 3, 2026
Published online: September 27, 2026
Processing time: 174 Days and 19.3 Hours
BACKGROUND
Semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, is increasingly prescribed for type 2 diabetes and obesity. Its perioperative safety remains uncertain due to concerns regarding delayed gastric emptying, increased residual gastric content (RGC), and possible aspiration-related complications.
AIM
To determine whether perioperative semaglutide use is associated with RGC, pulmonary aspiration, digestive symptoms, procedure discontinuation, and gastroparesis versus controls.
METHODS
We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. Seven electronic databases (Scopus, Web of Science, EMBASE, MEDLINE/PubMed, Latin American and Caribbean Health Sciences Literature, Cochrane Library, and OpenGrey) were searched from inception through April 2026. The methodological quality of observational studies was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence for each outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS
Twelve observational studies (49651 patients) were included; no randomized trials were identified. Methodological quality was generally high (Newcastle-Ottawa Scale 8-9), although residual confounding and selection bias remain inherent limitations of observational evidence. Semaglutide use was associated with increased risks of RGC [relative risk (RR) = 3.49, 95% confidence interval (CI): 1.78-6.83; moderate certainty)] and digestive symptoms (RR = 5.65, 95%CI: 3.61-8.84; moderate certainty). For pulmonary aspiration (RR = 1.46, 95%CI: 0.29-7.24; very low certainty), procedure discontinuation (RR = 1.74, 95%CI: 0.59-5.11; low certainty), and gastroparesis (RR = 1.43, 95%CI: 0.71-2.87; low certainty), the pooled estimates were imprecise and not statistically significant, and clinically important differences could not be excluded. Heterogeneity regarding RGC was substantial (I2 = 87.8%), which limits the interpretability of the pooled estimate.
CONCLUSION
Current observational evidence suggests that perioperative semaglutide use increases RGC and digestive symptoms, but clinical significance remains uncertain; aspiration-related outcomes require cautious interpretation and prospective standardized studies.
Core Tip: Perioperative semaglutide treatment was associated with an increased risk of residual gastric content and digestive symptoms. Evidence regarding pulmonary aspiration, gastroparesis, and procedure discontinuation remains uncertain because the available data are observational and imprecise. Prospective studies using standardized fasting, perioperative, and outcome definitions are needed.
