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

We report a case of gastric retention induced by tirzepatide in a 42-year-old female patient with a body mass index of 29.3 kg/m² who was scheduled for painless gastroscopy due to back distension and pain. The patient had fasted for 12 hours as required and was assessed with a difficult airway in the pre-anesthesia clinic, with no history of hypertension or diabetes mellitus noted initially. During gastroscopy, undigested semisolid food chyme was found in the gastric body, and gastric peristalsis was weakened, leading to the suspension of the procedure. Further inquiry revealed that the patient had received weekly subcutaneous injections of tirzepatide for weight management for one month. The patient was then instructed to discontinue tirzepatide for one week, adopt a liquid diet preoperatively, and extend the fasting time to 15 hours. A follow-up ultrasonic assessment showed no residual gastric contents, and the painless gastroscopy was completed successfully thereafter. Tirzepatide, a dual GIP/GLP-1 receptor agonist, delays gastric emptying through a central pathway, which is the primary cause of gastric retention in this case. This case highlights that anesthesiologists may overlook the medication history of GLP-1 receptor agonists when focusing on difficult airway assessment, leading to unanticipated gastric retention. Clinicians should conduct a comprehensive pre-anesthetic assessment including detailed medication history for patients using tirzepatide, and consider drug discontinuation, extended fasting and bedside ultrasonography as necessary to reduce the risk of regurgitation and aspiration during anesthesia.