Holding vs Continuing GLP-1/GIP Agonists Before Upper Endoscopy: The OCULUS Randomized Clinical Trial

Area of Science:

• Gastroenterology and Endocrinology
• Clinical Trial Research
• Pharmacology

Background:

• Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) agonists are associated with an increased risk of retained gastric contents.
• High-quality data are lacking to guide the periprocedural management of patients taking these medications.

Purpose of the Study:

• To compare the risk of clinically significant residual gastric volume (RGV) in patients who continue versus hold one dose of weekly or daily GLP-1 and GIP agonists prior to sedation.
• To evaluate the impact of GLP-1 and GIP agonists on periprocedural gastric emptying.

Main Methods:

• A randomized, single-masked clinical trial involving patients undergoing elective upper endoscopy (EGD) who were receiving GLP-1 or GLP-1/GIP agonists.
• Participants were randomized to either continue their medication or hold one dose prior to the procedure.
• Clinically significant RGV was defined as contents precluding examination, requiring termination/intubation, or causing an aspiration event.

Main Results:

• Clinically significant RGV occurred in 3.1% of patients holding one dose versus 25.0% in those continuing medication (P=.003).
• The trial was terminated early due to a significantly higher risk in the continue group.
• In the EGD-only subgroup, RGV was 5.0% in the hold group vs 46.7% in the continue group (P=.001). No RGV was observed in patients on clear liquids prior to EGD and colonoscopy.

Conclusions:

• Continuing GLP-1 or GIP agonists in the preprocedural period significantly increases the risk of clinically significant residual gastric volume.
• Holding one dose of these agonists appears to mitigate this risk.
• Adherence to clear liquid diets prior to procedures may reduce RGV risk, irrespective of GLP-1/GIP agonist use.