GLP-1 receptor agonist increase retained gastric contents on EGD and same-day colonoscopy reduces this risk

With the rise in glucagon-like peptide 1 receptor agonist (GLP-1RA) medication usage for Type 2 diabetes mellitus and weight loss, concerns have been raised regarding safety and primary aspiration risk when undergoing anesthesia procedures. Given the paucity of evidence, there is concern whether patients on GLP-1RA are at higher risk of retained gastric contents and subsequent adverse outcomes during routine esophagogastroduodenoscopy (EGD). This study aims to investigate whether patients on GLP-1RA are at higher risk of retained gastric contents during routine EGD.

In this retrospective study, we examined 1,368 adult patients who underwent EGDs in the outpatient setting at a tertiary care center. A multivariable analysis was conducted to predict the presence of retained gastric contents on EGD, with the primary predictor being GLP-1RA use. Covariates thought to contribute to delayed gastric emptying were used as secondary predictors.

Retained gastric contents were seen in 18 out of 128 cases in the GLP-1RA users (14.1%), which was statistically significant when compared to 45 out of the 1,156 non-users (3.8%) (p < 0.001, LR 18.323). There was no significant increase in adverse outcomes associated with this finding. GLP-1RA use (p < 0.001, OR = 5.4), history of gastroparesis (p < 0.001, OR = 4.55), chronic kidney disease (p = 0.036, OR = 3.47) and hemiplegia (p = 0.048, OR = 2.9) increased risk of retained gastric contents. In contrast, bowel prep (p = < 0.001, OR = 0.157) for same day lower GI procedures decreased risks.

Our results show an increase in retained gastric contents in GLP-1RA users undergoing EGD. Other mitigating factors and whether the increase results in aspiration complications should be further studied.