Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study

🥉 Top 5% JournalOct 22, 2024BMJ (Clinical research ed.)

Use of Glucagon-like Peptide-1 Drugs Before Upper Stomach and Throat Exams and the Risk of Breathing Problems or Stopping the Procedure

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Abstract

Among 43,365 adults with type 2 diabetes, the weighted risk of pulmonary aspiration was 4.15 per 1000 for GLP-1 receptor agonists and 4.26 for SGLT-2 inhibitors.

No increased risk of pulmonary aspiration was found for GLP-1 receptor agonist users compared to SGLT-2 inhibitor users (risk ratio 0.98).
GLP-1 receptor agonists were associated with a higher risk of endoscopy discontinuation (risk ratio 1.99) compared to SGLT-2 inhibitors.
The findings suggest that GLP-1 receptor agonists may lead to a higher risk of retained gastric content, influencing endoscopy procedures.
Results are based on a cohort study utilizing two US healthcare databases.

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OBJECTIVE: To assess whether use of glucagon-like peptide-1 (GLP-1) receptor agonists before upper gastrointestinal endoscopy is associated with increased risk of pulmonary aspiration or discontinuation of the procedure compared with sodium-glucose cotransporter-2 (SGLT-2) inhibitors.

DESIGN: Cohort study.

SETTING: Two deidentified US commercial healthcare databases.

PARTICIPANTS: 43 365 adults (≥18 years) with type 2 diabetes who used a GLP-1 receptor agonist or SGLT-2 inhibitor within 30 days before upper gastrointestinal endoscopy.

MAIN OUTCOME MEASURES: The primary outcome was pulmonary aspiration on the day of or the day after endoscopy, defined using diagnostic codes. The secondary outcome was discontinuation of endoscopy. Risk ratios and corresponding 95% confidence intervals (CIs) were estimated after fine stratification weighting based on propensity score.

RESULTS: After weighting, 24 817 adults used a GLP-1 receptor agonist (mean age 59.9 years; 63.6% female) and 18 537 used an SGLT-2 inhibitor (59.8 years; 63.7% female). Among users of GLP-1 receptor agonists and SGLT-2 inhibitors, the weighted risk per 1000 people was, respectively, 4.15 and 4.26 for pulmonary aspiration and 9.79 and 4.91 for discontinuation of endoscopy. Compared with SGLT-2 inhibitor use, GLP-1 receptor agonist use was not associated with an increased risk of pulmonary aspiration (pooled risk ratio 0.98, 95% CI 0.73 to 1.31), although it was associated with a higher risk for discontinuation of endoscopy (1.99, 1.56 to 2.53).

CONCLUSIONS: In this comparative cohort study, no increased risk of pulmonary aspiration during upper gastrointestinal endoscopy was observed among adults with type 2 diabetes using GLP-1 receptor agonists compared with SGLT-2 inhibitors within 30 days of the procedure; however, GLP-1 receptor agonists were associated with a higher risk of discontinuation of endoscopy, possibly owing to a higher risk of retained gastric content. In the absence of evidence from randomized trials, these findings could inform future practice recommendations on the preprocedural protocol for patients requiring endoscopy.

Key numbers

4.15 per 1000 people

Risk of Pulmonary Aspiration

Weighted risk among users

9.79 per 1000 people

Risk of Endoscopy Discontinuation

Weighted risk among users

1.99

Discontinuation Risk Ratio

Pooled risk ratio for discontinuation of endoscopy

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Abstract

Key numbers

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