GLP1-RAs linked to notably higher rate of retained gastric contents during upper endoscopy
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Key takeaways:
- Younger age, tirzepatide and oral semaglutide were associated with a higher risk for retained gastric contents.
- Prevalence increased from 9.4% to 11.6% when esophagogastroduodenoscopy evaluated upper GI symptoms.
More than 9% of patients on glucagon-like peptide-1 receptor agonists who underwent esophagogastroduodenoscopy had retained gastric contents, although the risk for aspiration remained low, according to study results.
Further, same-day colonoscopy was reported to reduce retained gastric contents, supporting the AGA’s recent clinical practice update that recommends implementation of a liquid diet the day before endoscopy, rather than holding medication among patients at average risk for aspiration.
“Glucagon-like peptide-1 receptor agonists (GLP-1RAs) work in part through delaying gastric emptying, raising concerns about retained gastric contents (RGC) during esophagogastroduodenoscopy (EGD),” Stephen A. Firkins, MD, of the Digestive Disease and Surgery Institute at the Cleveland Clinical Foundation, and colleagues wrote in Clinical Gastroenterology and Hepatology. “The American Society of Anesthesiologists currently recommends holding GLP-1RAs for one dosing cycle prior to elective procedures; however, the AGA advocates proceeding with endoscopy in asymptomatic patients, adhering to standard perioperative protocols without medication withholding and suggests implementing a liquid diet the day prior to endoscopy in lieu of stopping the medication.”
To quantify the rate of RGC encountered during EGD, researchers performed a single-center, retrospective analysis of 1,512 EGDs performed between January 2018 and October 2023 on patients taking GLP-1RAs (mean age, 60.9 years; 64.2% women; mean BMI, 35.2). Secondary outcomes included rates of aborted procedures, repeat procedures and adverse events.
According to results, 9.4% of patients had RGC, primarily consisting of solid residue (78.9%). Prevalence of RGC increased to 11.6% in EGDs that evaluated upper gastrointestinal symptoms, including abdominal pain, dyspepsia or indigestion, dysphagia, heartburn, reflux or nausea/vomiting.
Endoscopists aborted the procedure in 30 cases (2%), of which 29 had RGC. Researchers reported nine adverse events, which included four cases of intraprocedural hypoxia and two aspiration events. Researchers noted the risk for aspiration remained low, despite a high rate of RGC, and was “only marginally higher” compared with the general population (3-5/10,000).
Results from univariate analysis showed that younger age was significantly associated with higher risk for RGC (57.9 years vs. 61.3 years), as was tirzepatide (12% vs. 6.6%) and oral semaglutide (14% vs. 0.2%). Conversely, same-day colonoscopy protected against RGC (OR = 0.34; 95% CI, 0.23-0.52), a finding that, along with younger age, remained significant on multivariate analysis.
Further, the presence of RGC was significantly associated with procedural discontinuation (OR = 101.8; 95% CI, 30.3-341.5) and repeat procedure (OR = 223.6; 95% CI, 29.7-1,680). GLP-1RA type was no longer associated with an increased risk for RGC on multivariable analysis.
“We identified a 9.4% rate of RGC amongst patients taking GLP-1RAs who underwent EGD, which is significantly higher than that of the general population,” Firkins and colleagues wrote. “While this translated to a 2% risk of procedure abortion, aspiration risk remained low.”
They continued: “These results may help guide more accurate patient education and development of risk mitigation policies for periprocedural management of patients taking GLP-1RAs.”
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