Violeta Popov, MD, PhD: Do GLP-1 RAs Need to Be Held Before Endoscopy?

New research suggests patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may not need to stop taking the medication prior to upper endoscopic procedures.

Findings from the systematic review and meta-analysis were presented as a late-breaking abstract at the American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting in Philadelphia, Pennsylvania, and showed no association between GLP-1 RA use and aspiration risk. Of note, a higher rate of aborted endoscopies and retained gastric content was observed in patients receiving GLP-1RAs, but a clear liquid diet and bowel preparation may mitigate this risk without the need for GLP-1 RA discontinuation.

“GLP-1s, as we are all aware, have become increasingly prevalent for use in the treatment of diabetes and obesity,” Violeta Popov, MD, PhD, director of bariatric endoscopy at the VA NY Harbor Healthcare System, explained to HPCLive. “The reason why they prompt concern for gastrointestinal procedures is that GLP-1 agonists can impact the rate of gastric emptying. They have other effects on insulin, in the brain, and on the intestines, but the one that is concerning for GI endoscopy is their impact on the rate of gastric emptying and the potential to delay the rate of gastric emptying, which could lead to retained gastric contents and potentially could lead to one of the most feared outcomes of endoscopy, aspiration.”

In 2023, the American Society of Anesthesiologists released guidance suggesting patients hold GLP-1 RAs prior to endoscopy, which Popov noted had varying implications for different medications depending on whether the dosing was daily or weekly. Furthermore, she pointed out much more research has been done on this topic since this initial guidance was released, underscoring the need for a comprehensive overview of all available evidence. To accomplish this, Popov and a team of investigators conducted a systematic review and meta-analysis searching MEDLINE, Embase, and Cochrane Database through July 1, 2024.

In total, 35 studies including 13 published papers and 22 conference abstracts with 203,216 study subjects and 511,093 control subjects were included in the present analysis. The odds ratio (OR) for aspiration pneumonia after endoscopy with GLP-1RA use was 1.03 (95% CI, 0.61-1.73). It was reported in 0.3% (95% CI, 0.12%-0.87%) of GLP-1RA users and 0.23% (95% CI, 0.1%-0.67%) of non-GLP-1RA users.

The OR for aborted upper endoscopy in GLP-1RA users was 5.19 (95% CI, 3.5-7.70). It was reported for 1.9% (1.4%, 2.7%) of GLP-1RA users and 0.4% (0.2%, 1.0%) of non-GLP-1RA users.

Further analysis revealed the OR for retained gastric content in GLP-1RA was 4.38 (95% CI, 3.14-6.1) after upper endoscopy, with a rate of 12.5% (95% CI, 10.0%-15.4%) in GLP-1RA users and 3.4% (95% CI, 2.2%-5.0%) in non-GLP-1RA users. Of note, the rate of retained gastric content in GLP-1RA users undergoing both upper endoscopy and colonoscopy was 5.5% (95% CI, 3.6%-8.2%).

“This is going to be a moving target. Things will have to be updated very quickly and very frequently in the next few years, and we will see more and more patients taking these medications for various reasons, and we have to keep in mind that they can affect GI motility,” Popov said. “I just want to urge everyone to look at the data, follow the most up-to-date evidence-based data, and then make decisions for their practice based on that.”

Editors’ note: Popov received a research grant from Microtech Endoscopy.

Reference

^{Popov V, Bilal M, Ahmed AM, et al. 62 - GLP-1RA and Safety of Gastrointestinal (GI) Endoscopic Procedures A Systematic Review and Meta-Analysis (Late-Breaking Abstract). Paper presented at: ACG 2024 Annual Scientific Meeting. Philadelphia, Pennsylvania. October 25-30, 2024.}