GLP-1 RAs Increase Residual Gastric Content But Pose Low Medical Risk During Endoscopy

Use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) is associated with significantly increased rates of residual gastric content but has a minimal impact on upper endoscopy safety and completion, according to findings from a recent study.

The study, which was led by Braden Kuo, MD, a neurogastroenterologist and director of the Center for Neurointestinal Health at Massachusetts General Hospital, was presented at the American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting in Philadelphia, Pennsylvania, and suggests it may not be necessary to stop GLP-1 RA use for upper endoscopy, but direct use of general anesthesia could mitigate complications in higher risk cases.

“The big concern is that GLP-1s, by their mechanism of action, curb appetite, but they also potentially impact GI motility and slow down gastric emptying, thereby increasing the sensation of satiation and cutting down overall intake by mouth,” Kuo explained to HCPLive. “The fact that it may decrease gastric emptying may increase residual material in the stomach that could put the patient at risk. When you do endoscopy, if they have decreased airway protection, that increased stomach material could be jettisoned from their stomach into their airway and cause complications like aspiration.”

Although he noted his presentation was not the first to look at the potential risks posed by GLP-1 RAs during endoscopy, Kuo pointed out several unique aspects of his work, including the large sample size and the fact that patients were matched to controls by age, by sex, by level of obesity, by medical severity, and by diabetes.

Even after accounting for these factors, study results suggested an increased risk of gastric residual contents with GLP-1 RA use, indicating these variables do not impact the risk associated with GLP-1RAs. Of note, in patients having a concomitant colonoscopy, the risk of residual gastric contents was reduced (P <.05).

“There has been a lot of concern that these increased rates of gastric content material would precipitate a large number of negative outcomes, but our data suggests when you carefully case match the controls, the rate is actually very, very low,” Kuo said, asserting that although GLP-1 RAs increases the risk of residual gastric content, the overall medical risk is low.

Editors’ note: Kuo has relevant disclosures with ATMO, Phathom, and Takeda.

Reference

^{Karlson R, Clukey J, Beck V, et al. P0678 - Clinical Impact of GLP-1RA On Endoscopy: A Retrospective Cohort Study in Endoscopy Patients. Paper presented at: ACG 2024 Annual Scientific Meeting. Philadelphia, Pennsylvania. October 25-30, 2024.}