GLP-1 receptor agonists / dual GIP-GLP-1 agonists

The cited multisociety guidance supports individual assessment of gastric-emptying and metabolic risks, rather than automatic withholding for every patient.

Agents and formulations

Agents in this group include daily formulations (for example liraglutide and oral semaglutide) and weekly formulations (for example injectable semaglutide, dulaglutide and tirzepatide). They are prescribed for type 2 diabetes, weight management, or both. Weight-management use may not be recorded in the patient’s medical records, so direct questioning is important.

Why they matter

These agents delay gastric emptying. Case reports and observational studies have described retained gastric contents despite standard fasting. The magnitude of aspiration risk remains uncertain, but the concern is reflected in current guidance.

Current guidance

Current multi-society guidance and ADA 2026 support continuing therapy in many low-risk elective patients.

Factors informing that assessment include dose-escalation phase, higher doses, weekly formulations, GI symptoms and other conditions that delay gastric emptying.

Measures described in the guidance for higher-risk patients include a 24-h liquid diet, gastric ultrasound where expertise exists, modification of the anaesthesia plan to address aspiration risk, or a delay when appropriate.

If withholding is chosen

If withholding is chosen, the optimal duration is uncertain. The 2024 multisociety document notes that evidence for duration is unknown and references the older ASA suggestion of holding daily formulations on the day of surgery and weekly formulations for a week. ADA 2026 notes that even a one-week hold may be insufficient to eliminate residual gastric-content risk.

In patients with diabetes, withholding may worsen glycaemic control and needs a glucose plan.

Practical application

Recording the agent, dose, frequency, last dose and recent dose changes helps establish risk.
Questions about nausea, vomiting, bloating, abdominal pain, constipation and early satiety can inform assessment both before and on the day of the procedure.
Early communication gives the patient time to follow any agreed preparatory diet and diabetes plan.
These considerations can also be relevant to procedural sedation, including endoscopy.
Documenting the aspiration-risk assessment and rationale can support consistent care across the team.