Food retention with GLP-1s may vary by endoscopic procedure

On By Pranco

TOP LINE:

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

METHODOLOGY:

  • GLP-1 RAs can lead to delayed gastric emptying and constipation. The American Society of Anesthesiologists guidelines recommend discontinuing its use 7 days prior to elective endoscopic procedures.
  • Researchers assessed the potential associations between the use of 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 and 139 nonusers based on age, body mass index, sex, and type of procedure. Exclusion criteria included 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 due to bowel discomfort or a total Boston Bowel Preparation Scale score of less than 6 out of 9 or a score of 0 out of 3 for a single bowel segment.
  • The retained solid gastric contents were identified based on the endoscopist’s report.

TAKEAWAY:

  • Of all participants, 33% underwent EGD alone, 33% underwent colonoscopy alone, and 34% underwent both EGD and colonoscopy.
  • Food retention occurred in 17.4% of GLP-1 RA users undergoing EGD alone, compared with none of the non-users (odds ratio (OR), 21.5). No food retention was observed when EGD was combined with colonoscopy, probably due to bowel preparation.
  • In adults undergoing colonoscopy alone or combined EGD colonoscopy, inadequate bowel preparation was more common among GLP-1 RA users than 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 pre-procedural and same-day counseling when scheduled procedures may be canceled due to GLP-1 RAs not being performed. Importantly, our findings suggest that patients who adhere to colonoscopy preparation guidelines are at low risk for gastric content retention 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 opened.

LIMITS:

The study was limited by its retrospective design and the inability to match 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.

DISCLOSURE:

No funding source is included in the study. The authors reported no conflicts of interest.