GLP-1 receptor agonists associated with retention of gastric contents during endoscopy
Patients taking glucagon-like peptide-1 (GLP-1) receptor agonists did not have any increase in upper endoscopy adverse events, a review found, leading the authors to suggest that longer fasting time before procedures would be sufficient to avoid the risks.
For patients undergoing upper endoscopy, taking glucagon-like peptide-1 (GLP-1) receptor agonists is associated with greater retention of gastric contents but not risk of aspiration, a meta-analysis found.
Researchers identified 13 studies (mostly conducted in the U.S.) involving a total of 84,065 patients who underwent upper endoscopy; all studies were retrospective and compared outcomes by whether patients were taking GLP-1 receptor agonists or not. The primary outcome of the review was the rate of retained gastric contents; secondary outcomes included rates of aborted and repeated procedures, adverse events, and aspiration. Results were published by Clinical Gastroenterology and Hepatology on Aug. 12.
Patients receiving GLP-1 receptor agonists had a significantly higher rate of retained gastric contents (odds ratio [OR], 5.56; 95% CI, 3.35 to 9.23); the rate was also elevated among patients taking the medication for diabetes (OR, 2.60; 95% CI, 2.23 to 3.02). The association remained significant after adjustment for variables such as sex, age, body mass index, diabetes, and other medications (adjusted OR, 4.20; 95% CI, 3.42 to 5.15). Procedures were more often aborted (OR, 5.13; 95% CI, 3.01 to 8.75) and repeated (OR, 2.19; 95% CI, 1.43 to 3.35) in the GLP-1 receptor agonist patients. However, overall adverse events and aspiration rates were not significantly elevated in those taking the drugs (ORs, 4.04 [95% CI, 0.63 to 26.03] and 1.75 [95% CI, 0.64 to 4.77], respectively).
“It should be noted that including standard interruption of GLP-1 [receptor agonist] therapy in all patients undergoing endoscopic procedures would add more complexity to periprocedural management and exacerbate barriers while delaying care for patients requiring endoscopic procedures,” said the study authors, who offered the alternative solution of putting patients on a liquid diet the day before endoscopy, prolonging the duration of fasting from solid food for at least 12 hours.
Limitations of the review include that all of the studies were retrospective, some of them were only presented as conference abstracts, and some studied outcomes did not occur in many patients.