GLP-1RA use linked with risk for food retention in single endoscopic procedures
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Key takeaways:
- Gastric food retention occurred in 17.4% of the GLP-1RA group undergoing endoscopy alone vs. 0% of the control group.
- The risk for food retention was low when endoscopy was combined with colonoscopy.
Use of glucagon-like peptide-1 receptor agonists was associated with an increased risk for gastric food retention during single endoscopic procedures, although this risk was low when combined with colonoscopy, according to research.
“We undertook this study in part because of the increase in the use of these [glucagon-like peptide-1 receptor agonists (GLP-1RAs)] and also because of the concerns that have been raised regarding potential associations between GLP-1RA use and increased risk of periprocedural aspiration by the American Society of Anesthesiology and others,” Ruchi Mathur, MD, professor of medicine and director of clinical research and clinical operations for the Medically Associated Science and Technology Program at Cedars-Sinai in Los Angeles, told Healio. “This study is unique in examining these risks in EGD (esophagogastroduodenoscopy) alone and comparing this to EGD performed with colonoscopy.”
To investigate this possible link, Mathur and colleagues conducted a retrospective, cross-sectional study of adult patients undergoing endoscopy at Cedars-Sinai during the first six months of 2023. They enrolled 70 patients on GLP-1RAs (mean age, 62.7 years; 51.4% women; mean BMI, 34.4 kg/m2) and 139 control patients, who were matched by age, BMI, sex and procedure. Overall, 33% underwent EGD, 33% colonoscopy and 34% both EGD and colonoscopy.
Outcomes of interest included gastric food retention, periprocedural aspiration and inadequate bowel preparation.
Among patients who underwent only EGD, 17.4% in the GLP-1RA group experienced food retention, which did not occur in the control group (OR = 21.5; 95% CI, 1.1-414.9). The researchers reported no food retention with combined procedures. According to Mathur, this “protective effect” may be caused by bowel preparation protocols, such as the 24-hour clear liquid diet, required for colonoscopy.
Similarly, inadequate bowel preparation occurred more frequently in the GLP-1RA group compared with the control group (21.3% vs. 6.5%; OR = 3.9; 95% CI, 1.3-11.6) among those undergoing colonoscopy or combined procedures, which “may contribute to missed lesions, patient dissatisfaction and procedure cancellation with wasted resources,” Mathur added.
The researchers observed no aspiration events, respiratory distress or aspiration pneumonia.
“Our study demonstrates a significant association between use of GLP-1RAs and increased risks of retained stomach contents and inadequate bowel preparation during upper endoscopy procedures,” Mathur said. “Our results support the value of individualizing recommendations for patients and having risk-benefit discussions for patients on these medications.”
Mathur continued: “This was a small study and was also a retrospective study. Larger prospective studies are required to confirm these findings. A larger study would also allow for the assessment of specific drugs in the class vs. a class effect.”
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