Association Between Semaglutide or Tirzepatide Therapy and Residual Gastric Content: A Potential Danger During Upper Endoscopy

Introduction This study aims to evaluate the risk of residual gastric content (RGC) among patients taking semaglutide/tirzepatide undergoing an esophagogastroduodenoscopy (EGD). Methods A retrospective observational study was conducted from 2024 to 2025 for 144 patients who had been taking semaglutide/tirzepatide and were undergoing an EGD. The primary outcome was evaluating the presence of RGC, and the secondary outcomes were procedure-related complications. Statistical analysis included Fisher's exact test, Spearman's correlation, and Firth's logistic regression. Results Among the 144 patients, 12 patients were taking semaglutide or tirzepatide for more than six months. Eleven of whom had RGC (seven semaglutide and four tirzepatide). No RGC was noted in the 132 patients who did not meet the inclusion criteria. Fischer's exact test showed a significant association between GLP-1 usage for over six months and the presence of RGC (p<0.001). Spearman's correlation found a moderate positive association between RGC and age, but a weak negative association with body mass index (BMI). Firth's logistic regression further demonstrated a good model fit (pseudo-R² of 0.943), but the individual predictors (glucagon-like peptide-1 (GLP-1) type, age, and BMI) were not statistically significant. There were no procedure-related complications, and the patients were discharged on the same day. Conclusion Semaglutide/tirzepatide for over six months resulted in RGC despite following the standard fasting protocol before EGD.