Impact of GLP-1 receptor agonists on upper gastrointestinal endoscopy: an updated systematic review and meta-analysis

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used to treat diabetes and obesity. Emerging evidence suggests that GLP-1 RAs may be linked to increased gastric residual content (GRC), aspiration pneumonia, and aborted esophagogastroduodenoscopy (EGD) procedures. Although a recent meta-analysis showed an increased risk of GRC and aborted EGDs with GLP-1 RA use, it could not definitively establish a link to aspiration events due to limited data. This systematic review and meta-analysis aims to update the evidence on the impact of GLP-1 RAs on EGD outcomes, evaluate the effect of concurrent colonoscopy (CLN) on GRC, and assess the influence of different GLP-1 RA agents on GRC.

We conducted a systematic review of studies from PubMed, Embase, and Cochrane databases (until November 2024), as well as relevant abstracts from Digestive Disease Week (DDW) 2024 and American College of Gastroenterology (ACG) 2024 to assess the impact of GLP-1 receptor agonists (GLP-1 RAs) on EGD. The primary outcomes were the rate of GRC and the rate of aspiration pneumonia. Secondary outcomes included the incidence of aborted EGDs due to GRC, the effect of concurrent CLN on GRC, and a comparison of GRC risk among different GLP-1 RA agents. A network meta-analysis was conducted to assess differences in GRC risk across the various GLP-1 RAs. Results were expressed in odds ratios (ORs) and 95% confidence intervals (CI). Moreover, to account for possible confounders, adjusted ORs (mainly based on age, sex, body mass index [BMI], diabetes) were pooled and analyzed. Meta-analysis was conducted using a random-effects model in Stata 17.

The primary analysis assessing the association between GLP-1 RA use and GRC or aspiration events included 20 retrospective studies with a total of 207,708 patients (23,366 GLP-1 RA users). GLP-1 RA use demonstrated significantly higher rates of GRC compared to non-users (OR: 5.57; 95% CI: 4.07-7.62), an association that remained statistically significant on the analysis of adjusted ORs (3.18; 95% CI: 2.75-3.67). Furthermore, rates of aborted EGDs were higher with GLP-1 RA use (OR 4.90; 95% CI: 2.94-8.18), while there was no difference in aspiration events between the two groups (OR 1.75; 95% CI: 0.64-4.77). Concurrent colonoscopy was found to reduce GRC risk among GLP-1 RA users (OR 0.27; 95% CI: 0.19-0.38). A network meta-analysis comparing semaglutide (PO/SQ), exenatide, liraglutide and dulaglutide in terms of GRC showed no significant difference across these agents (chi square 0.966, p = 0.96).

This updated systematic review and meta-analysis found a significant association between GLP-1 RA use and increased GRC. While GLP-1 RA use was linked to higher rates of aborted procedures, no difference in aspiration events was observed between the two groups. Notably, our study identified a protective effect of concurrent colonoscopy on GRC among GLP-1 RA users, while no significant differences were found in GRC risk among different GLP-1 RA agents. Further prospective studies are needed to control for potential confounders and better assess the true impact of GLP-1 RA use on EGD outcomes.