Endoscopy and anesthesia outcomes associated with glucagon-like peptide-1 receptor agonist use in patients undergoing outpatient upper endoscopy

Background and Aims

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) can cause delayed gastric emptying, raising concern for retained gastric contents (RGC) during endoscopy and adverse anesthesia events. The aim of this study was to determine associations between GLP-1RA and endoscopy and anesthesia outcomes.

Methods

This single-center, retrospective cohort study examined patients prescribed GLP-1RAs who underwent outpatient endoscopy stratified according to exposure at the time of endoscopy. The GLP-1RA group had ≥6 weeks of exposure as confirmed by pharmacy dispensation reports. The control group were patients not taking GLP-1RAs at the time of endoscopy (prescription never filled, discontinued ≥6 weeks prior, or started postendoscopy). The outcomes were the presence of solid RGC, aborted procedures, or any adverse anesthesia events.

Results

A total of 598 patients were included in the study; 360 were taking GLP-1RAs, and 298 were control subjects. Baseline characteristics, including age, sex, chronic opiate use, gastroparesis, and prior gastric surgery, were similar, but diabetes mellitus was more prevalent in the GLP-1RA group (68% vs 57%; P = .005). The odds of solid RGC was significantly higher in the GLP-1RA group in multivariate analysis (odds ratio, 3.80; 95% confidence interval, 1.57-9.21; P = .003), but odds were not increased in patients undergoing concurrent colonoscopy. More patients in the GLP-1RA group had procedures aborted (1.3% vs 0%; P = .021), but rates of hypoxia were similar (.2% vs .3%; P = .341). There were no cases of pulmonary aspiration.

Conclusions

Patients taking GLP-1RAs have increased rates of solid RGC during upper endoscopy (but not with concurrent colonoscopy) and higher rates of aborted procedures but similar rates of adverse anesthesia events.