Glucagon-like peptide-1 receptor agonists and retained gastric contents on endoscopy: a prospective observational...

Retrospective evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with retained gastric contents (RGC) after standard 8-hr fasting, possibly increasing aspiration risk. The primary aim of this study was to compare the incidence of RGC on upper endoscopy after appropriate preoperative fasting in patients taking GLP-1 RAs vs patients not taking GLP-1 RAs.

We conducted prospective observational study of 256 patients scheduled for elective endoscopy involving stomach visualization. The primary outcome was RGC, defined as solid content or liquid-only content > 1.5 mL·kg^-1 body weight. Control patients followed standard 8-hr fasting, while patients taking GLP-1 RAs were instructed to hold this medication 1 week prior and were limited to a preprocedural 24-hr clear liquid diet. We measured RGCvia suctioning whenever possible and recorded subjective physician impressions. Secondary outcomes included aspiration events, procedure abortion, and conversion to general anesthesia. We evaluated the differences between groups using two-sample t tests or Wilcoxon rank-sum test for continuous and ordinal variables and Chi square tests or Fisher's exact test for categorical variables. We analyzed potentially confounding variables via logistic regression.

There was no statistically significant difference in the incidence of RGC between patients taking GLP-1 RAs (8%) vs controls (6%, P = 0.55). There were no occurrences of aspiration events, procedure abortion, or relevant conversion to general anesthesia. Endoscopy physician-reported concern of significant gastric contents was higher in the GLP-1 RA group compared with the control group (19% vs 7%).

In this small observational study, no statistically significant increase in RGC was noted when preprocedural instructions advised patients to hold GLP-1 RAs 1 week prior to endoscopy and follow a preprocedural 24-hr clear liquid diet.