Coming full circle: could glucagon-like peptide-1 receptor agonists confer a net perioperative benefit?

Despite a clear association with an increased incidence of unsuspected full stomach presentations, and the release of numerous societal guidelines recommending caution, the relation between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and periprocedural pulmonary aspiration is debatable. Several large retrospective studies (with serious limitations) have found risk either slightly increased or, more commonly, unchanged, compared with non-users. Completing these findings, a new observational study demonstrates a substantial inverse relation, in association with improvement in mortality, cardiovascular risk, and a host of other outcomes. These surprising and fortunate findings recall a multitude of recently demonstrated beneficial effects of GLP-1RA therapy in nonsurgical patients, and reveals a complex, potentially bidirectional relationship between GLP-1RA use and the risk of periprocedural aspiration.