Unanticipated Residual Gastric Contents in an Appropriately Fasted Pediatric Patient on Glucagon-Like Peptide-1 Receptor Agonist Therapy: A Case Report and Review of Perioperative Considerations.

Lookabaugh M, Strupp KM, Webb L

Cureus20 Dec 2025Cited by 1 (Europe PMC)

PMID41573454PMCIDPMC12822851DOI10.7759/cureus.99731PepBankPUB-41573454

Summary

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including semaglutide (Wegovy®), are increasingly used for weight management in both adult and pediatric populations. Their mechanism of delayed gastric emptying raises concern for aspiration during anesthesia, yet current fasting guidelines provide limited direction for these patients. We present the case of a 14-year-old female patient with autism, developmental delay, and obesity managed with semaglutide who presented for esophagogastroduodenoscopy and colonoscopy. Despite holding semaglutide for 12 days, completing bowel preparation, and fasting from solids for 32 hours and clear liquids for 10 hours, preoperative gastric point-of-care ultrasound revealed a distended antrum containing fluid and particulate matter consistent with a full stomach. After multidisciplinary discussion and informed consent, the procedure proceeded with rapid sequence induction and endotracheal intubation to mitigate aspiration risk. Endoscopy confirmed substantial residual gastric contents exceeding 200 mL, though the procedure and anesthetic course were uneventful. This case underscores that standard fasting protocols may not ensure gastric emptying in patients on GLP-1 RA therapy, particularly during medication up-titration or in those with coexisting gastrointestinal motility disorders. Point-of-care gastric ultrasound proved valuable for individualized risk assessment and anesthetic planning. As the use of GLP-1 RAs expands, anesthesia teams should maintain heightened vigilance, consider extended fasting or gastric ultrasound when feasible, and engage in shared decision-making regarding perioperative management. Further research and updated guidelines are needed to define evidence-based fasting intervals and anesthetic strategies for this growing patient population.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study1

1 result from studies that gave the peptide. 1 result from people.

01HumanCase report or seriesSafety outcome
In a 14-year-old with obesity on semaglutide, gastric ultrasound and endoscopy showed substantial residual gastric contents despite holding semaglutide for 12 days and prolonged fasting.
In plain wordsA 14-year-old on semaglutide still had a full stomach after holding the drug for 12 days and fasting for many hours.
Peptide
Semaglutide
Outcome
Not applicableResidual gastric contents despite fasting
Study
n = 1
Outcome group
Gastrointestinal adverse events · Gastrointestinal
Studied dose
Dose not stated
Source sentences
Summary
Despite holding semaglutide for 12 days, completing bowel preparation, and fasting from solids for 32 hours and clear liquids for 10 hours, preoperative gastric point-of-care ultrasound revealed a distended antrum containing fluid and particulate matter consistent with a full stomach.
1 context sentence(design, population, supporting numbers)
Summary · context
Endoscopy confirmed substantial residual gastric contents exceeding 200 mL, though the procedure and anesthetic course were uneventful.
Show in the study text Report a problemFND-4157345401

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Version history

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Version 2Current
11 Oct 2026, 00:04 UTC
Study results updated
Version 1
9 Oct 2026, 03:06 UTC
First added · source update from Europe PMC

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