Unmasking Aspiration Risks: A Propensity-Matched Odyssey of GLP-1 Receptor Agonists and Colonoscopy

The use of glucagon-like peptide-1(GLP-1) receptor agonists has revolutionized the treatment of Type 2 diabetes mellitus and morbid obesity. They are known to slow gastric emptying and potentially increase the risk of pulmonary aspiration perioperatively. We aim to conduct a retrospective study to evaluate the risk of aspiration pneumonia in patients on GLP-1 receptor agonists undergoing colonoscopy.

A large research network (TriNetX LLC) comprising over 100 million patients was leveraged to obtain data from 2016 to 2024. Patients who underwent colonoscopy during the study period were divided into GLP-1 users and non-users. The primary outcomes were aspiration pneumonia and hospitalization following colonoscopy. The secondary outcomes were respiratory failure and the need for mechanical ventilation within 7 days of colonoscopy.

Before propensity score matching, the study included 126 663 patients on GLP-1 agonists and 1 380 652 not on GLP-1 agonists. Propensity score matching resulted in balanced cohorts of 126 663 patients per group. After propensity score matching, the risk ratio for aspiration pneumonia in the GLP-1 agonist group was 0.70 (95% confidence interval, 0.50-0.98), suggesting a trend towards reduced risk and does not suggest increased risk of aspiration pneumonia. Similarly, no significant differences were observed in mechanical ventilation, respiratory failures, or hospitalization rates between the two groups.

This large retrospective study shows no increased risk of aspiration pneumonia with GLP-1 agonist use, in patients undergoing screening colonoscopy. These findings suggest that minimally sedated gastroscopy prior to colonoscopy, routine GLP-1 agonist withholding, and overly restrictive fasting are not required.