Effects of Glucagon-Like Peptide-1 Receptor Agonists on Upper Gastrointestinal Endoscopy: A Meta-Analysis

Aug 14, 2024Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

How Glucagon-Like Peptide-1 Receptor Agonists Affect Upper Gut Examinations: A Meta-Analysis

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Abstract

Patients receiving GLP-1 receptor agonists had 5.56 times higher rates of retained gastric content during upper endoscopy.

GLP-1RA therapy is linked to significantly higher rates of retained gastric content compared to non-users.
In patients with diabetes, the rate of retained gastric content is also elevated, with an odds ratio of 2.60.
Adjusted analyses confirm higher rates of retained gastric content in GLP-1RA users, with an adjusted odds ratio of 4.20.
Aborted and repeated procedures during endoscopy were more frequent in GLP-1RA users, with odds ratios of 5.13 and 2.19, respectively.
No significant differences in adverse event and aspiration rates were observed between GLP-1RA users and non-users.

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BACKGROUND AND AIMS: Limited evidence exists regarding the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on upper endoscopy. Therefore, a meta-analysis was conducted to comprehensively review the available evidence on this subject.

METHODS: A systematic bibliographic search was carried out until May 2024. Pooled estimates were analyzed using a random-effects model, with results presented as odds ratio (OR) and 95% confidence interval (CI). The primary outcome assessed was the rate of retained gastric content (RGC), while secondary outcomes included rates of aborted and repeated procedures, adverse event rate, and rates of aspiration.

RESULTS: This analysis included 13 studies involving a total of 84,065 patients. Patients receiving GLP-1RA therapy exhibited significantly higher rates of RGC (OR, 5.56; 95% CI, 3.35 to 9.23), a trend that was consistent among patients with diabetes (OR, 2.60; 95% CI, 2.23 to 3.02). Adjusted analysis, accounting for variables such as sex, age, body mass index, diabetes, and other therapies, confirmed the elevated rates of RGC in the GLP-1RA user group (adjusted OR, 4.20; 95% CI, 3.42 to 5.15). Furthermore, rates of aborted and repeated procedures were higher in the GLP-1RA user group (OR, 5.13; 95% CI, 3.01 to 8.75; and OR, 2.19; 95% CI, 1.43 to 3.35; respectively). However, no significant differences were found in AE and aspiration rates between the 2 groups (OR, 4.04; 95% CI, 0.63 to 26.03; and OR, 1.75; 95% CI, 0.64 to 4.77; respectively).

CONCLUSION: Use of GLP-1RAs is associated with increased retention of gastric contents and more frequent aborted procedures during upper endoscopy. However, the adverse event and aspiration rates do not seem different; therefore, adjusting fasting time instead of routinely withholding GLP-1RAs could be reasonable in these patients.

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Effects of Glucagon-Like Peptide-1 Receptor Agonists on Upper Gastrointestinal Endoscopy: A Meta-Analysis

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