Quantified Metrics of Gastric Emptying Delay by Glucagon-Like Peptide-1 Agonists: A Systematic Review and Meta-Analysis With Insights for Periprocedural Management

Abstract

Introduction: Divergent recommendations for periprocedural management of glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1 RA) medications rely on limited evidence. We performed a systematic review and meta-analysis to provide quantitative measures of gastric emptying relevant to mechanisms of weight loss and to periprocedural management of GLP-1 RA. We hypothesized that the magnitude of gastric emptying delay would be low and of limited clinical significance to procedural sedation risks.

Methods: A protocolized search identified studies on GLP-1 RA that quantified gastric emptying measures. Pooled estimates using random effects were presented as a weighted mean difference with 95% confidence intervals (CIs). Univariate meta-regression was performed to assess the influence of GLP-1 RA type, short-acting vs long-acting mechanism of action, and duration of treatment on gastric emptying.

Results: Fifteen studies met the inclusion criteria. Five studies (n = 247) utilized gastric emptying scintigraphy. Mean T 1/2 was 138.4 minutes (95% CI 74.5-202.3) for GLP-1 RA vs 95.0 minutes (95% CI 54.9-135.0) for placebo, with a pooled mean difference of 36.0 minutes (95% CI 17.0-55.0, P < 0.01, I2 = 79.4%). Ten studies (n = 411) utilized the acetaminophen absorption test, with no significant delay in gastric emptying measured by T max , area under the curve (AUC) 4hr , and AUC 5hr with GLP-1 RA ( P > 0.05). On meta-regression, the type of GLP-1 RA, mechanism of action, and treatment duration did not impact gastric emptying ( P > 0.05).

Discussion: While a gastric emptying delay of ∼36 minutes is quantifiable on GLP-1 RA medications, it is of limited magnitude relative to standard periprocedural fasting periods. There were no substantial differences in gastric emptying on modalities reflective of liquid emptying (acetaminophen absorption test), particularly at time points relevant to periprocedural care.

Figure 1:

Overview of Study Selection (PRISMA Flow Chart).

Figure 2:

Gastric Emptying Study (Scintigraphy) Primary Outcome (T_1/2, minutes), Pooled Mean Difference

Figure 3:

Acetaminophen Absorption-Based Measurement of Gastric Emptying Primary Outcome (T_max, minutes), Pooled Mean Difference

Figure 4:

Acetaminophen Absorption Studies Secondary Outcome [Area Under the Curve (AUC, μmol*hr/L)], Pooled Mean Difference. (A) AUC at 1 hour, (B) AUC at 4 hours, (C) AUC at 5 hours

Figure 4:

Acetaminophen Absorption Studies Secondary Outcome [Area Under the Curve (AUC, μmol*hr/L)], Pooled Mean Difference. (A) AUC at 1 hour, (B) AUC at 4 hours, (C) AUC at 5 hours

Figure 4:

Acetaminophen Absorption Studies Secondary Outcome [Area Under the Curve (AUC, μmol*hr/L)], Pooled Mean Difference. (A) AUC at 1 hour, (B) AUC at 4 hours, (C) AUC at 5 hours

Figure 5A:

Funnel Plot Assessment of Publication Bias, Gastric Emptying study (Scintigraphy)

Figure 5B:

Funnel Plot Assessment of Publication Bias, Acetaminophen Absorption Studies