GLP-1 RA Use Increases Risk of Food Retention, Poor Bowel Preparation in Endoscopy

New research is calling attention to an increased risk of retained gastric contents and inadequate bowel preparation during single endoscopic procedures among patients who use glucagon-like peptide-1 receptor agonists (GLP-1 RAs).¹

Results from the cross-sectional study showed that even when patients held GLP-1 RAs for 7 days prior to the procedure, they were still more likely to show food retention during upper endoscopy than patients who were not taking these medications. Findings also linked GLP-1 RA use to unsatisfactory bowel preparation for colonoscopies, potentially leading to missed lesions, patient dissatisfaction, and wasted resources.¹

In parallel with the rising popularity of GLP-1 RAs, interest in the potential adverse effects of these agents has also grown, particularly regarding their perioperative safety in the context of gastrointestinal procedures. In 2023, the American Society of Anesthesiologists raised concerns about the potential association between GLP-1 RA use and risk of periprocedural aspiration, recommending that they be held prior to the procedure. Still, questions remain about their overall gastrointestinal impact and how this may vary in the context of different endoscopic procedures.^1,2

To investigate potential associations between GLP-1 RA use and the risk of gastric food retention and periprocedural aspiration during esophagogastroduodenoscopies (EGDs), both when EGD was combined with colonoscopy and in colonoscopy alone, investigators conducted a retrospective, cross-sectional study of adults undergoing endoscopy at a single center between January 1, and June 28, 2023. Exclusion criteria included the use of prokinetics, surgically modified gastrointestinal anatomy, and exposure to GLP-1 RAs within 90 days without actively taking them within 7 days of the procedure.¹

Patients taking GLP-1 RAs at the time of endoscopy were identified and matched in a 1:2 ratio with individuals in a control group based on age, body mass index (BMI) subgroup, sex, and procedure. Investigators defined inadequate preparation as aborting the procedure due to stool burden or a Boston Bowel Preparation Scale score < 6 (total possible score, 9) or 0 (total possible score, 3) in any single bowel segment. Retained solid gastric content was identified based on endoscopist report.¹

A total of 70 individuals taking GLP-1 RAs and 139 controls were included in the study. Among the cohort, 33% of patients underwent EGD, 33% underwent colonoscopy, and 34% underwent both. In the GLP-1 RA group, 46% of patients received semaglutide, 30% received dulaglutide, 20% received tirzepatide, and 4% received liraglutide.¹

Results showed food retention occurred in 4 (17.4%) individuals in the GLP-1 RA group undergoing EGD alone (1 moderate, 3 large) compared with none of the individuals in the control group (odds ratio [OR], 21.5; 95% CI, 1.1-414.9; P = .01). Investigators noted no food retention was observed in combined EGD-colonoscopies, which require a 24-hour clear liquid and bowel preparation protocol.¹

"This protective effect against food retention may be due to the preparation typically required for colonoscopies, as opposed to upper endoscopies," Ruchi Mathur, MD, a professor of medicine and director of clinical research and clinical operations for Medically Associated Science and Technology at Cedars-Sinai, said in a press release.³

Among individuals who underwent colonoscopy or combined EGD-colonoscopies, investigators noted inadequate bowel preparation was more common in the GLP-1 RA group than in the control group (21.3% vs 6.5%; OR, 3.9; 95% CI, 1.3-11.6). Despite this, no aspiration events, respiratory distress, or aspiration pneumonia visits occurred during the study in either group.¹

Investigators outlined multiple limitations to these findings, including the retrospective study design; the inability to match for diabetes or account for other factors such as glycemia; the lack of consideration for differential associations of individual GLP-1 RAs and doses; and a sample size that precluded analysis of rare events like aspiration.¹

"Overall, our results support the value of individualizing recommendations for patients and having risk-benefit discussions for patients on these drugs," Mathur said.³ "Any patients using a GLP-1 RA drug should be sure to inform their physicians and anesthesiologists before undergoing gastrointestinal procedures."

References

1. ^{Nasser J, Hosseini A, Barlow G, et al. Food Retention at Endoscopy Among Adults Using Glucagon-Like Peptide-1 Receptor Agonists. JAMA Netw Open. 2024;7(10):e2436783. doi:10.1001/jamanetworkopen.2024.36783}
2. ^{American Society of Anesthesiologists. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. June 29, 2023. Accessed October 4, 2024. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative}
3. ^{Cedars-Sinai. Diabetes Drugs May Affect Endoscopy Patients. October 3, 2024. Accessed October 4, 2024. https://www.cedars-sinai.org/newsroom/diabetes-drugs-may-affect-endoscopy-patients/}