Confounding Factors in the Association Between Glucagon-Like Peptide-1 Receptor Agonist Use and Retained Gastric...

Introduction The use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) has gained acceptance in managing diabetic and non-diabetic patients, thanks to its benefits in treating obesity and improving cardiovascular outcomes. The potential ability of GLP-1 RA to cause retained gastric contents (RGC) which can lead to aspiration has led to the recommendation to withhold GLP-1 RA for at least one week prior to elective surgeries and procedures, including upper endoscopies and colonoscopies. However, many co-medications and conditions associated can contribute to delayed gastric emptying (DGE) and these need to be controlled to establish a clear association and incidence, which has been largely missing in most studies and reports. Our aim was to assess clinically significant delayed gastric emptying (CSDGE) related to GLP-1 RA in a "real world" situation by controlling for some common confounding factors. Method We carried out an eight-year retrospective single-center study to assess the relationship between CSDGE and the use of GLP-1 RA among asymptomatic patients undergoing upper endoscopies while controlling for common confounding factors. Result Out of the 3415 patients who had esophagogastroduodenoscopy (EGD) with or without colonoscopy (Ew/woC) during the eight-year period, 129 eligible patients were found to have CSDGE. The use of GLP-1 RA was associated with the lowest percentage frequency distribution of CSDGE, at 2%, and opiate accounted for more percentage frequency distribution, at 35%. The odds ratio for patients on GLP-1 RA who developed CSDGE was 2.5 (95% CI 0.75-8.29). All patients who had CSDGE while on GLP-1 RA were also on other medications or had conditions associated with DGE. Conclusion Our result confirmed the possible effect of confounding factors in the association between CSDGE and GLP-1 RA among asymptomatic patients undergoing Ew/woC. While the need to ensure patients' safety cannot be overemphasized, the proper approach currently favors assessing patients on a case-by-case basis while we await the results of large prospective controlled studies.