Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study
Open accessAbstract
Purpose We aimed to estimate the association of glucagon-like peptide 1 (GLP-1) receptor agonist therapy with the incidence of endoscopically visible gastric contents after preprocedural fasting. Methods We reviewed the records of esophagogastroduodenoscopy (EGD) performed at our institution between 2019 and 2023 and determined the presence of residual gastric contents from the procedure notes and saved images. We compared patients taking GLP-1 agonists at the time of the procedure (GLP group, 90 procedures) with patients who started GLP-1 agonist therapy within 1,000 days after undergoing EGD (control, 102 procedures). We excluded emergent procedures without fasting, combined EGD/colonoscopy procedures, and patients with known gastroparesis or previous gastric surgery. We estimated the association between GLP-1 agonist therapy and residual gastric contents with a confounder-adjusted generalized linear mixed effect model. Results Compared with controls, the GLP cohort had a higher age, American Society of Anesthesiologists' Physical Status, and incidence of nausea and diabetes mellitus. Body mass index and fasting duration were comparable between groups. Visible gastric content was documented in 17 procedures in the GLP group (19%) and in five procedures in the control group (5%), with an associated confounder adjusted odds ratio of 5.8 (95% confidence interval, 1.7 to 19.3; P = 0.004). There were five instances of emergent endotracheal intubation in the GLP group vs one case in control and one case of pulmonary aspiration vs none in control. Conclusions In fasting patients, GLP-1 agonist therapy was associated with an increased incidence of residual gastric contents, potentially posing an additional risk of periprocedural pulmonary aspiration.
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GLP-1 RAs are associated with delayed gastric emptying in most settings.
“There is clear evidence that GLP‐1 RAs are associated with delayed gastric emptying in most settings, as shown by: endoscopy [45, 46, 47, 48] (including capsular [49]); sonography [50, 51]; radiolabelled carbon ingestion [52, 53]; paracetamol ingestion [6, 7, 54, 55, 56, 57, 58, 59]; and scintigraphy [29, 60, 61].”
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- Authors
- Wu, F., Smith, M. R., Mueller, A. L., Klapman, S. A., Everett, L. L., Houle, T., Kuo, B., & Hobai, I. A.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- Corresponding author
- Hobai, Ion A.
- Venue
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Published
- 2024-03-14
- Volume
- 71
- Issue
- 7
- Pages
- 958-966
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W4392796059
- Cited by
- 71
- References
- 6
- Citations by year
- 2026: 10 · 2025: 38 · 2024: 23
- FWCI
- 29.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- GLP-1 receptor agonists, residual gastric content, preprocedural fasting, upper gastrointestinal endoscopy, pulmonary aspiration, endotracheal intubation, diabetes mellitus, gastroparesis
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Adult, Aged, Anesthesia, Fasting, Female, Gastrointestinal Contents, Humans, Male, Middle Aged, Retrospective Studies, Cohort Studies, Endoscopy, Digestive System
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