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The following is a summary of “Endoscopy and Anesthesia Outcomes Associated with Glucagon-Like Peptide-1 Receptor Agonist Use in Patients Undergoing Outpatient Upper Endoscopy,” published in the January 2025 issue of Gastroenterology by Panchal et al.

Glucagon-like peptide-1 receptor agonists (GLP1RAs) are known to delay gastric emptying, which raises concerns about the presence of retained gastric contents during endoscopic procedures and potential adverse anesthesia events. This study aimed to investigate the associations between GLP1RA use and outcomes related to endoscopy and anesthesia. In this single-center retrospective cohort study, patients prescribed GLP1RAs who underwent outpatient endoscopy were categorized based on their exposure to the medication at the time of the procedure. The GLP1RA group consisted of individuals with at least six weeks of confirmed exposure, verified through pharmacy dispensation reports. The control group included patients who were not on GLP1RAs at the time of endoscopy, either due to never filling the prescription, discontinuing use at least six weeks prior, or initiating treatment post-endoscopy. The primary outcomes assessed were the presence of solid RGCs, aborted procedures, and any adverse anesthesia events.

The study included 598 patients, with 360 in the GLP1RA group and 298 in the control group. Baseline characteristics such as age, sex, chronic opioid use, gastroparesis, and previous gastric surgery were similar between groups, although the prevalence of diabetes mellitus was significantly higher in the GLP1RA group (68% vs. 57%, p=0.005). Multivariate analysis revealed that the odds of encountering solid RGCs were significantly higher in the GLP1RA group (OR 3.80; 95% CI 1.57-9.21; p=0.003), whereas no increased odds were observed in patients undergoing concurrent colonoscopy. Additionally, a higher proportion of procedures were aborted in the GLP1RA group (1.3% vs. 0%, p=0.021), although rates of hypoxia were comparable between the two groups (0.2% vs. 0.3%, p=0.341). Importantly, no instances of pulmonary aspiration were reported.

In conclusion, the use of GLP1RAs is associated with an increased incidence of solid RGCs during upper endoscopy and a higher likelihood of aborted procedures, though this does not extend to concurrent colonoscopy or elevate the rates of adverse anesthesia events. These findings highlight the need for careful pre-procedural assessment and potential adjustments in clinical practice for patients on GLP1RAs undergoing endoscopy.

Source: sciencedirect.com/science/article/pii/S0016510725000094