ABSTRACT
INTRODUCTION: While ubiquity of glucagon-like peptide receptor agonists (GLP1-RAs) is rising, guidance from the gastroenterology societies and American Society of Anesthesiologist (ASA) remains in conflict on recommendations regarding preoperative holding prior to endoscopy. This study aims to address this by evaluating the effect of GLP1-RAs on gastric retention during upper endoscopy. METHODS: This multicenter cross-sectional study included patients on confirmed GLP1-RAs receiving an endoscopy from 2021-2023. Demographics, prescribing practices, and procedure outcomes were captured. GLP1-RA management of preoperative holding was retroactively classified per ASA guidance. Multivariable logistic regression was performed to assess factors influencing retained gastric contents. RESULTS: Of 815 patients, 70 (8.7%) had retained gastric contents on endoscopy of whom 65 (93%) had type 2 diabetes mellitus (T2DM). Only 1 (1.4%) of these patients required unplanned intubation and none had aspiration events. Those with GLP1-RA held per ASA guidance (406, 49.8%) were less likely to have retained contents (4.4 vs 12.7%, p<0.001), but there were no significant differences to intubation (0% vs 2%, p=0.53) or aborting procedure rates (28% vs 18%, p=0.40) due to gastric retention. On multivariable analysis, likelihood of food retention increased 36% (95%CI 1.15-1.60) for every 1% increase in HbA1C after adjusting for GLP1-RA type and preoperative medication hold. CONCLUSION: In this multicenter study, very low rates of retained gastric contents were seen during endoscopy in patients on GLP1-RAs and most were in patients with T2DM. Our findings suggest an individualized approach rather than universal pre-operative holding of medications prior to endoscopy.
