Food Retention With GLP-1s May Vary by Endoscopic Procedure

TOPLINE:

The use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) is associated with a higher risk for retained gastric contents in upper endoscopy but not when the procedure is combined with colonoscopy, and also with inadequate bowel preparation in colonoscopy alone or with upper endoscopy.

METHODOLOGY:

• GLP-1 RAs may lead to delayed gastric emptying and constipation. The American Society of Anesthesiologists guidance advises stopping their use 7 days prior to elective endoscopic procedures.
• Researchers assessed the potential associations between the use GLP-1 RAs and the risks of gastric food retention and periprocedural aspiration during esophagogastroduodenoscopy (EGD) alone or with colonoscopy, as well as the risks of inadequate bowel preparation with colonoscopy.
• The retrospective, cross-sectional study included 70 adults using GLP-1 RAs matched to 139 nonusers based on age, body mass index, sex, and type of procedure. Exclusion criteria included the use of prokinetics, surgically modified gastrointestinal anatomy, and exposure to GLP-1 RAs within 90 days and stopped within 7 days of the procedure.
• Inadequate bowel preparation was defined as aborting the procedure owing to stool burden or a Boston Bowel Preparation Scale total score of less than 6 out of 9 or a score of 0 out of 3 for any single bowel segment.
• Retained solid gastric content was identified based on the endoscopist report.

TAKEAWAY:

• Among all participants, 33% underwent EGD alone, 33% underwent colonoscopy alone, and 34% underwent both EGD and colonoscopy.
• Food retention occurred in 17.4% GLP-1 RA users undergoing EGD alone vs none of the nonusers (odds ratio [OR], 21.5). No food retention was observed when EGD was combined with colonoscopy, likely due to the bowel prep requirements.
• For adults undergoing colonoscopy alone or combined EGD-colonoscopy, inadequate bowel preparation was more common in GLP-1 RA users than in nonusers (21.3% vs 6.5%; OR, 3.9).
• No aspiration events, respiratory distress, or aspiration pneumonia occurred.

IN PRACTICE:

“Our results support the value of individualizing recommendations and inform the risk-benefit discussion for preprocedural counseling and same-day counseling when scheduled procedures may be canceled because GLP-1 RAs are not held. Importantly, our findings suggest that patients who adhere to colonoscopy preparation guidance may be at a low risk of retained gastric contents and aspiration,” the researchers wrote.

SOURCE:

The study, with first author Jason Nasser, MD, Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, was published online in JAMA Network Open.

LIMITATIONS:

The study was limited by its retrospective design and an inability to match for diabetes or account for other factors, such as glycemia, or to assess differential associations of individual GLP-1 RAs and doses. The small sample size precluded analysis of rare events, such as aspiration.

DISCLOSURES:

The study did not include a funding source. The authors reported no conflicts of interest.