Endoscopy and Anesthesia Outcomes Associated with Glucagon-Like Peptide-1 Receptor Agonist use in Patients Undergoing Outpatient Upper Endoscopy

Glucagon-like peptide-1 receptor agonists (GLP1RAs) can cause delayed gastric emptying, raising concern for retained gastric contents (RGCs) during endoscopy and adverse anesthesia events. We aimed to determine associations between GLP1RA and endoscopy and anesthesia outcomes. This single-center retrospective cohort study examined patients prescribed GLP1RA who underwent outpatient endoscopy stratified by exposure at the time of endoscopy. The GLP1RA group had ≥6 weeks of exposure as confirmed by pharmacy dispensation reports. The control group were patients not on GLP1RA at the time of endoscopy (prescription never filled, discontinued ≥6 weeks prior, or started post-endoscopy). The outcomes were the presence of solid RGCs, aborted procedures or any adverse anesthesia events. 598 patients were included in the study with 360 on GLP1RA and 298 controls. Baseline characteristics including age, sex, chronic opiate use, gastroparesis and prior gastric surgery were similar, but diabetes mellitus was more prevalent in the GLP1RA group (68% vs. 57%, p=0.005). The odds of solid RGCs was significantly higher in the GLP1RA group in multivariate analysis (OR 3.80; 95% CI 1.57-9.21; p=0.003), but odds were not increased in patients undergoing concurrent colonoscopy. More patients in the GLP1RA group had procedures aborted (1.3% vs. 0%, p=0.021), but rates of hypoxia were similar (0.2% vs. 0.3%, p=0.341). There were no cases of pulmonary aspiration. Patients on GLP1RAs have increased rates of solid RGCs during upper endoscopy, but not with concurrent colonoscopy, and higher rates of aborted procedures, but similar rates of adverse anesthesia events.