GLP-1 RA use before endoscopy tied to low retained gastric contents

Patients taking glucagon-like peptide 1 receptor agonists (GLP-1 RAs), particularly those with type 2 diabetes (T2D), have very low rates of retained gastric contents during endoscopy, as shown in a study.

A total of 815 patients on confirmed GLP-1 RAs who underwent an endoscopy from 2021 to 2023 were included in this multicentre cross-sectional study. The investigators obtained data on demographics, prescribing practices, and procedure outcomes. They also retroactively classified GLP-1 RA management of preoperative holding per American Society of Anesthesiologist guidance. Finally, factors influencing retained gastric contents were identified using multivariable logistic regression.

Of the patients, 70 (8.7 percent) had retained gastric contents on endoscopy. Among these, 65 (93 percent) had T2D, and only one (1.4 percent) required unplanned intubation. None of them had aspiration events.

On the other hand, patients on GLP-1 RA (n=406, 49.8 percent) were less likely to have retained gastric contents (4.4 percent vs 12.7 percent; p<0.001). However, no significant differences to intubation (0 percent vs 2 percent; p=0.53) or aborting procedure rates (28 percent vs 18 percent; p=0.40) due to gastric retention were observed.

After adjusting for GLP-1 RA type and preoperative medication hold, multivariable analysis revealed a 36-percent (95 percent confidence interval [CI], 1.15–1.60) increased likelihood of food retention for every 1-percent increase in haemoglobin A1c.

“Our findings suggest an individualized approach rather than universal preoperative holding of medications before endoscopy,” the investigators said.