Glucagon-Like Peptide-1 Receptor Agonists Increase Solid Gastric Residue Rates on Upper Endoscopy Especially in Patients With Complicated Diabetes: A Case-Control Study

Mar 27, 2024The American journal of gastroenterology

Medications That Activate Glucagon-Like Peptide-1 Receptors May Increase Solid Stomach Residue During Upper Endoscopy, Especially in People with Complicated Diabetes

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Abstract

Rates of gastric residue during upper endoscopy were 14% in patients using glucagon-like peptide-1 receptor agonists (GLP-1RAs) compared to 4% in matched controls.

GLP-1RA use is associated with significantly higher rates of gastric residue during endoscopy, particularly in individuals with type 2 diabetes mellitus (T2DM).
In T2DM patients, gastric residue rates were 14% for GLP-1RA users versus 4% for non-users.
Insulin-dependent patients showed even higher gastric residue rates at 17%, compared to 5% in controls.
Prolonged fasting and a clear-liquid diet were linked to lower rates of gastric residue, at 2% compared to 11%.
While 22% of patients with gastric residue required intubation and 25% had early procedure termination, no procedural complications or aspiration incidents were reported.

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INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) prescribed for weight loss and type 2 diabetes mellitus (T2DM) can delay gastric emptying, but risk factors and impact on procedure outcomes remain unclear.

METHODS: We compared frequency of gastric residue on upper endoscopy in patients on a GLP-1RA and propensity score-matched controls in this retrospective case-control study of consecutive patients undergoing endoscopic procedures over a 3.5-year period. GLP-1RAs were not held before endoscopy. The gastric residue presence was assessed by reviewing endoscopy reports and images. Predictors and consequences of gastric residue with GLP-1RA were determined.

RESULTS: In 306 GLP-1RA users compared with matched controls, rates of gastric residue were significantly higher with GLP-1RA use (14% vs 4%, P < 0.01), especially in patients with T2DM (14% vs 4%, P < 0.01), with insulin dependence (17% vs 5%, P < 0.01) and T2DM complications (15% vs 2%, P < 0.01). Lower gastric residue rates were noted after prolonged fasting and clear liquids for concurrent colonoscopy (2% vs 11%, P < 0.01) and in patients with afternoon procedures (4% vs 11%, P < 0.01). While 22% with gastric residue required intubation and 25% had early procedure termination, no procedural complications or aspiration were recorded.

DISCUSSION: GLP-1RA use is associated with increased gastric residue on upper endoscopy, particularly in patients with T2DM, surpassing the impact of opiates alone. Risk is highest in the presence of T2DM complications while prolonged fasting and a clear-liquid diet are protective. This increased risk of gastric residue does not appear to translate to an increased risk of procedural complications.

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Glucagon-Like Peptide-1 Receptor Agonists Increase Solid Gastric Residue Rates on Upper Endoscopy Especially in Patients With Complicated Diabetes: A Case-Control Study

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