Impact of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) on Food Content During Esophagogastroduodenoscopy (EGD)

Abstract

Background Glucagon-like peptide-1 receptor agonists (GLP-1RA) have delayed gastric emptying properties; however, the impact on esophagogastroduodenoscopy (EGD) visualization is unknown. Objective: This study examines the impact of GLP-1RA use on EGD visualization and gastric content retention. Methods: This was a retrospective cohort study with matched controls. The primary endpoint was the odds of retained food documented during EGD. Secondary endpoints included incidence of lavage and need for repeat EGD due to poor visualization and were compared using Fisher exact test. Analyses were performed in R Studio. Results: There were 59 patients in the cohort prescribed a GLP-1RA with 118 matched controls. Food retention was documented with 4 patients (6.8%) in the GLP-1RA cohort versus 2 patients (1.7%) in the control group (odds ratio [OR] 4.22 [95% CI 0.87-20.34]). No difference was observed in the need for lavage during EGD or in the need for repeat EGD attributed to poor visualization. Conclusion and Relevance: This study addresses a previously uninvestigated question in clinical practice. GLP-1RA did not significantly increase odds of retained food on EGD. Although a numerical difference was observed, it did not reach statistical difference. No cases required repeat EGD due to poor visualization, and no change to EGD pre-procedure instructions were warranted at the study facility.

Anesthetic Considerations in Adult Patients on Glucagon-Like Peptide-1 Receptor Agonists: Gastrointestinal Focus

“…Of note, a large retrospective study (n = 85,116) observed that only 3% of EGD patients had RGV. 7 In this study, the use of a GLP-1RA (6/85,116 patients) was not associated with increased residual gastric content. 10 These authors concluded that RGV encountered during EGD should only be used as a surrogate for delayed gastric emptying.…”

“…A retrospective cohort study of patients taking GLP-1RA (n = 59) with matched controls (n = 118) reported RGV in 6.8% (4 of 59) patients taking GLP-1RA versus 1.7% (2 of 118) in the control group. 7 Another case-control study observed an overall 1.5% (17 of 1128) incidence of RGV in unmatched patients undergoing EGD. 8 With propensity score matching (n = 205 pairs) these authors reported that even after ≥12 hours of fasting, RGV was 5.4% in patients taking a GLP-1RA compared with 0.5% controls.…”

“…5 In September 2023, the US Food and Drug Administration updated the warning label for Ozempic (semaglutide) to include ileus along with the current list of side effects (ie, nausea, vomiting, diarrhea, and constipation). 6 Delayed gastric emptying as well as ileus can increase the residual gastric volume (RGV), [7][8][9][10][11] even if current preoperative fasting recommendations are followed. 12,13 This can increase the risk of regurgitation and pulmonary aspiration of gastric contents during sedation or general anesthesia.…”

Particulate Gastric Contents in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists After Appropriate Perioperative Fasting: A Report of 2 Cases

“…In contrast, a recent retrospective cohort study comparing 59 patients on GLP-1 agonist therapy to 118 matched controls assessing for retained gastric food on EGD failed to reach a statistically significant difference; although, this study may have benefitted from a larger sample size. 15 In conclusion, the risk of perioperative aspiration with patients on GLP-1 therapy is not clear. However, as both our patients had large volumes of particulate gastric contents, a cautious approach is needed.…”

“…In contrast, a recent retrospective cohort study comparing 59 patients on GLP-1 agonist therapy to 118 matched controls assessing for retained gastric food on EGD failed to reach a statistically significant difference; although, this study may have benefitted from a larger sample size. 15…”