Case Report: Gastric Retention Induced by Tirzepatide in a Patient Undergoing Gastroscopy

Preprint. Posted on Research Square. Not yet peer reviewed. This is a single case report — generalizability is limited, but the mechanism described is well-established.

Summary

Case report of gastric retention during gastroscopy in a 42-year-old woman (BMI 29.3) who had been on weekly subcutaneous Tirzepatide for 1 month for weight management. Despite the standard 12-hour preoperative fast, undigested semi-solid food was found in the gastric body during the procedure, which had to be suspended. Resolution required 1 week of tirzepatide discontinuation, a preoperative liquid diet, 15 hours of fasting, and bedside ultrasound confirmation before the gastroscopy was successfully rescheduled.

Key Findings

• Standard fasting protocols (~12 hours) may be insufficient for patients on tirzepatide
• Gastric retention was severe enough to abort a planned procedure and raise aspiration risk
• Mechanism: tirzepatide’s dual GIP/GLP-1 receptor agonism delays gastric emptying through a central pathway (well-documented pharmacology; this case demonstrates clinical implication)
• Successful management: drug hold + liquid diet + extended fasting + bedside ultrasound verification
• Patient had no diabetes and no prior notable medication history, highlighting that non-T2DM weight-management use cases are a growing perioperative risk population

Methodology

Single case report from a clinical encounter. No controls, no primary data beyond the described case.

Limitations

• N = 1
• Preprint — not peer reviewed
• Does not establish the incidence rate of significant gastric retention in tirzepatide users undergoing endoscopy/anesthesia
• The 1-month treatment duration is relatively short; longer-duration users may have different profiles

Relevance to Content

Highly practical for the VialBase audience. Many readers are using or considering Tirzepatide or Semaglutide for weight management, and most will at some point need a procedure involving anesthesia or endoscopy. This case report plus existing ASA guidance suggest a concrete preoperative checklist:

1. Flag any GLP-1 RA use (including off-label, compounded, or weekly dosing) in the pre-anesthetic interview
2. Consider 1-week hold before elective procedures involving general anesthesia or endoscopy
3. Extend fasting to 12–24 hours or use a clear-liquid diet for 24 hours preoperatively
4. Request bedside gastric ultrasound if full-stomach risk is suspected

Useful for:

• A standalone “peptides and surgery” practical guide
• A safety callout in the Tirzepatide profile and the Semaglutide profile
• Pairing with 42013898-glp1-wound-outcomes-free-flap-reconstruction for a “two sides of the perioperative picture” piece — wound-healing benefit vs aspiration risk

See Also

• Tirzepatide
• 42013898-glp1-wound-outcomes-free-flap-reconstruction