Glucagon-like peptide-1 receptor agonist use and the risk of residual gastric content and aspiration in patients undergoing gastrointestinal endoscopy: a systematic review and a meta-analysis

Muhammad Usman Baig; Allison Piazza; Ali Lahooti; Kate Elise Johnson; Sean Rangwani; Zane Gouda; Srihari Mahadev; Carolyn Newberry; Mark Hanscom; Kartik Sampath; Sonal Kumar; Diana Anca; Allison Raye Schulman; David Leslie Carr-Locke; Reem Z Sharaiha

doi:10.1016/j.gie.2024.12.019

Glucagon-like peptide-1 receptor agonist use and the risk of residual gastric content and aspiration in patients undergoing gastrointestinal endoscopy: a systematic review and a meta-analysis

Gastrointest Endosc. 2024 Dec 16:S0016-5107(24)03794-5. doi: 10.1016/j.gie.2024.12.019. Online ahead of print.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
² Samuel J. Wood Library, Weill Cornell Medicine, New York, NY, USA.
³ Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
⁴ Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
⁵ Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. Electronic address: [email protected].

PMID: 39694296
DOI: 10.1016/j.gie.2024.12.019

Abstract

Background: GLP-1 receptor agonists are used for type 2 diabetes mellitus and obesity, but safety concerns have been raised for users undergoing gastrointestinal endoscopy, regarding retained food and aspiration events.

Aims: We aim to compare the risk of complications for GLP-1 users and non-users undergoing endoscopy.

Methods: We conducted a systematic review and meta-analysis (PROSPERO Registration: CRD42024556732). A systematic search in PubMed, Scopus, Web of Science, and Cochrane Central was performed from their inception until 1^st July, 2024 (Embase from 1974 to 28^th June, 2024). Double-arm human adult original studies (observational, RCT) with a sample size of 20 or more undergoing EGD or endoscopy with no GLP-1 RA use in the control arm were searched. Studies were excluded if they were single-arm and had any use of GLP-1 before the procedure in the control arm. Residual gastric contents (RGC), aspiration pneumonia, and premature endoscopy termination were the main outcomes. The random-effects model was used to pool and get final effect estimates.

Results: 23 observational studies were selected consisting of 262,018 patients. GLP1 RA users had a statistically significant increase in the risk of RGC (OR 4.54, 95% CI 3.30-6.24, p<0.00001, I²⁼ 68%) and premature endoscopy termination (OR 4.54, 95% CI 3.05-6.75, p<0.00001, I²⁼ 0%). There was no significant difference in the risk of aspiration pneumonia (OR 0.96, 95% CI 0.53-1.75, p=0.90, I²⁼ 70%). A significant reduction was seen in RGC when EGD & colonoscopy (OR= 0.28 [0.22, 0.36], p<0.00001; I2= 0%) were done the same day vs EGD alone (Figure 1 Graphical abstract).

Conclusions: GLP-1 RA use was associated with an increased risk of RGC and premature endoscopy termination, but no significant difference was found in the risk of aspiration pneumonia patients undergoing endoscopy.

Publication types

Review