‘No strong evidence’ to support discontinuation of GLP-1RAs prior to upper endoscopy
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Key takeaways:
- GLP-1RA use prior to upper endoscopy correlated with a higher rate of retained gastric content (OR = 5.56).
- However, the incidence of adverse events – particularly bronchial aspiration – was low.
Although glucagon-like peptide-1 receptor agonist use prior to upper endoscopy was linked to a higher rate of retained gastric contents, evidence supports prolonged fasting as the “optimal approach” rather than routine discontinuation.
“Despite limited available data, the American Society of Anesthesiologists has recently issued consensus-based perioperative guidance suggesting that glucagon-like peptide-1 receptor agonists (GLP-1RAs) should be withheld prior to the procedure or surgery, regardless of the indication, dose or the type of procedure/surgery,” Antonio Facciorusso, MD, PhD, of the department of medical and surgical sciences at the University of Foggia in Italy, and colleagues wrote in Clinical Gastroenterology and Hepatology.
They continued, “The AGA has recommended an individualized approach to managing patients on GLP-1RAs in the pre-endoscopic setting, citing the scarce data supporting this policy.”
Facciorusso and colleagues conducted a meta-analysis of 13 retrospective comparative studies, which included a total of 84,065 patients, to assess the effect of GLP-1RA use on upper endoscopy procedures. Their search included the terms GLP-1, semaglutide, dulaglutide or liraglutide and endoscopy.
Outcomes included the rate of retained gastric content among GLP-1RA users and nonusers, as well as rates of aborted procedures, repeated endoscopy and adverse events.
According to study results, GLP-1RA use was associated with significantly higher rates of retained gastric content (OR = 5.56; 95% CI, 3.35-9.23). Sensitivity analyses showed consistent results among patients with diabetes (OR = 2.6; 95% CI, 2.23-3.02) and based on the duration of fasting prior to endoscopy ( 12 hours: OR = 5.47; 95% CI, 2.16-13.87 vs. < 12 hours: OR = 4.07; 95% CI, 2.33-7.09).
In addition, pooled analyses that accounted for sex, age, BMI, diabetes status and other therapies confirmed GLP-1RA use was linked to higher rates of retained gastric content (adjusted OR = 4.2; 95% CI, 3.42-5.15), as well as higher rates of aborted endoscopy (OR = 5.13; 95% CI, 3.01-8.75) and repeat endoscopy (OR = 2.19; 95% CI, 1.43-3.35).
However, no significant differences were reported between groups in rates of adverse events (OR = 4.04; 95% CI, 0.63-26.03) or bronchial aspiration (OR = 1.75; 95% CI, 0.64-4.77).
“Our comprehensive analysis indicates that while the use of GLP-1RA results in higher rates of [retained gastric content], the actual clinical impact appears to be limited,” Facciorusso and colleagues wrote. “Therefore, there is no strong evidence to support the routine discontinuation of the drug before upper endoscopy procedures.”
They continued: “Additionally, the incidence of adverse events, particularly aspiration, is low and not significantly different between the two groups. Hence, prolonging the duration of fasting for solids could represent the optimal approach in these patients although this strategy requires further evaluation.”
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