Glucagon-like peptide-1 receptor agonists increase the risk of residual gastric content and pulmonary aspiration on upper endoscopy: A meta-analysis

📖 Top 20% JournalMar 25, 2025Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

Glucagon-like peptide-1 receptor drugs may raise the risk of leftover stomach contents and lung aspiration during upper endoscopy

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Abstract

The use of GLP1 receptor agonists is associated with a 4.86-fold increased risk of residual gastric content.

GLP1 receptor agonists are linked to a heightened risk of pulmonary aspiration, with an odds ratio of 2.29.
Patients receiving GLP1 receptor agonists experienced more interruptions in endoscopic procedures, indicated by an odds ratio of 3.22.
There is a 2.16-fold increased likelihood of needing repeated endoscopy among those treated with GLP1 receptor agonists.
Gastric transit time during capsule endoscopy is delayed by an average of 45.51 minutes in patients using GLP1 receptor agonists.

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BACKGROUND AND AIMS: Glucagon-like peptide-1 receptor agonists (GLP1-RA) are associated with increased residual gastric content (RGC); however, there is debate about their impact on RGC-related clinical outcomes, particularly aspiration.

METHODS: PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched for studies published up to January 4, 2025, comparing GLP1-RA with control groups (non-GLP1-RA) in patients undergoing endoscopy. The outcomes of interest included the risk of RGC, pulmonary aspiration, interrupted and repeated endoscopic procedures, and delays in gastric transit time during capsule endoscopy. For the meta-analysis, a random-effects model was used to calculate the pooled odds ratio (OR) and mean difference (MD) with 95 % confidence intervals (CIs).

RESULTS: Thirty-nine studies composed of a total of 1,253,498 subjects, were included. The pooled analysis demonstrated that the GLP1-RA group had a significantly increased risk of RGC (OR 4.86, 95 % CI 3.85-6.14; adjusted OR 5.24, 95 % CI 3.49-7.87), pulmonary aspiration (OR 2.29, 95 % CI 1.36-3.87), interrupted endoscopic procedures (OR 3.22, 95 % CI 1.65-6.29), repeated endoscopy (OR 2.16, 95 % CI 1.14-4.11), and delays in gastric transit time during capsule endoscopy (MD 45.51, 95 % CI 1.33-89.68).

CONCLUSIONS: GLP1-RA use increased the risk of RGC, pulmonary aspiration, interrupted and repeated endoscopy and gastric transit time, reducing the safety and completion of upper endoscopy.

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