Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about residual gastric content (RGC) and aspiration risk during elective procedures requiring anesthesia or sedation. RGC is a surrogate intermediate outcome that is distinct from clinical aspiration, which is a rarer event. This systematic review synthesizes available clinical evidence evaluating the association of peri-procedural mitigation strategies, including modified fasting protocols, medication withholding, and gastric point-of-care ultrasound (POCUS), with RGC reduction in GLP-1 RA users. A systematic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was conducted from inception to March 2026. Only original human studies were included; secondary research was excluded from the qualitative synthesis. Because study designs, populations, and outcome definitions differed substantially, findings were synthesized narratively at the study level; no meta-analysis was performed. Nineteen clinical studies, plus one administrative claims study, were analyzed separately and met the inclusion criteria. In one retrospective study, a 24-hour clear liquid diet was associated with lower RGC (approximately 1-2% versus 10%; odds ratio ≈ 0.13). In prospective ultrasound studies, withholding weekly GLP-1 RAs for 7-8 days was associated with lower odds of high RGC compared to shorter intervals. Multiple studies found that gastric POCUS using validated thresholds (>1.5 mL/kg or presence of solids) identified patients at increased risk. Aspiration events were rare and inconsistently reported across mitigation studies. The administrative claims study was analyzed separately as a distinct evidence tier and was not combined with clinical cohorts. Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced RGC in selected patient populations. However, the evidence base remains limited, and a modest aspiration risk cannot be excluded. Large, prospective randomized trials are urgently needed.
