Background and AimsGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are commonly prescribed for diabetes and obesity; however, their use may complicate anesthetized procedures due to delayed gastric emptying. This study sought to define rates of retained solid gastric contents, a risk factor for peri-procedural complications, in a population taking semaglutide. MethodsThis is a retrospective cohort study comparing individuals undergoing upper endoscopy over a 5-year period at a tertiary care center who were prescribed semaglutide, a long-acting GLP-1RA, for more than 4 weeks against a matched control cohort not on the medication. Multivariant logistic regression and multivariable propensity-matched association analysis were conducted to compare outcomes of interest including retained solid gastric contents, endoscopic complications, and endoscopic outcomes. ResultsIn total, 1212 patients comprised the study population (602 on semaglutide, 610 not on semaglutide). On multi-variant logistic regression analyzing causes of delayed gastric emptying, semaglutide was an independent risk factor for retained solid gastric contents (OR 4.74, 95% CI 2.40-9.35, p <0.0001). On multivariable propensity-matched association analysis utilizing demographic and clinical characteristics, semaglutide use was associated with an absolute increase of 6% of retained solid gastric contents (coefficient 0.0644, 95% CI 0.034-0.095, p<0.0001). Same-day colonoscopy was protective against this finding (OR 0.41, 95% CI 0.23-0.73, p=0.003). Intubation was rare and not associated with semaglutide use (OR 0.70, 95% CI 0.30-1.64, p=0.41). No peri-procedural aspiration events occurred. ConclusionsSemaglutide was an independent risk factor for retained solid gastric contents, even when accounting for confounding factors. This was negated in patients undergoing same-day colonoscopy, indicating an opportunity for pre-procedural fasting protocols in the absence of medication hold.