Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2024; 30(26): 3221-3228
Published online Jul 14, 2024. doi: 10.3748/wjg.v30.i26.3221
Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study
Haider Ghazanfar, Nismat Javed, Abeer Qasim, Franklin Sosa, Faryal Altaf, Shazia Khan, Jaydeep Mahasamudram, Abhilasha Jyala, Sameer Datta Kandhi, Dongmin Shin, Nikhitha Mantri, Haozhe Sun, Siddarth Hanumanthu, Harish Patel, Jasbir Makker, Bhavna Balar, Anil Dev, Sridhar Chilimuri
Haider Ghazanfar, Abhilasha Jyala, Sameer Datta Kandhi, Dongmin Shin, Nikhitha Mantri, Haozhe Sun, Harish Patel, Jasbir Makker, Bhavna Balar, Anil Dev, Sridhar Chilimuri, Division of Gastroenterology, Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, United States
Nismat Javed, Abeer Qasim, Franklin Sosa, Faryal Altaf, Shazia Khan, Jaydeep Mahasamudram, Siddarth Hanumanthu, Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, United States
Author contributions: Ghazanfar H, Patel H, Makker J, Balar B, Dev A and Chilimuri S conceptualized the study; Javed N, Qasim A, Sosa F, Altaf F, Khan S, Mahasamudram J, Kandhi SD and Hanumanthu S were involved in data curation; Ghazanfar H, Kandhi SD, Jyala A, Shin D, Mantri N, Sun H and Hanumanthu S were involved in data analysis and investigation; Ghazanfar H, Kandhi SD, Jyala A, Shin D, Mantri N, Sun H, Patel H, Makker J, Balar B, Dev A and Chilimuri S designed the methodology of the study; Ghazanfar H, Patel H, Makker J, Balar B, Dev A and Chilimuri S were involved in project administration; Patel H, Makker J, Balar B, Dev A and Chilimuri S provided resources; Javed N, Sosa F, Khan S, Hanumanthu S and Shin D were involved in software acquisition; Patel H, Makker J, Balar B, Dev A and Chilimuri S were involved in supervision; Data validation was performed by Javed N, Qasim A, Altaf F, Khan S, Hanumanthu S and Shin D; Visualization was done by Javed N, Qasim A and Altaf F; The first draft of the study was written by Ghazanfar H, Javed N, Qasim A, Sosa F, Altaf F, Khan S, Mahasamudram J, Kandhi SD and Shin D; The draft was revised by Ghazanfar H, Javed N, Kandhi SD, Shin D, Mantri N, Sun H, Patel H, Makker J, Balar B, Dev A and Chilimuri S. All authors agreed to be responsible for all aspects of the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the BronxCare Health System.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sameer Datta Kandhi, MD, Division of Gastroenterology, Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, 1650 Selwyn Avenue Suite 10 C, Bronx, NY 10457, United States. skandhi@bronxcare.org
Received: March 26, 2024
Revised: May 14, 2024
Accepted: June 24, 2024
Published online: July 14, 2024
Processing time: 104 Days and 16.2 Hours
Abstract
BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective in diabetes and obesity, reducing hyperglycemia by increasing insulin release and delaying gastric emptying. However, they can cause gastroparesis, raising concerns about aspiration during procedures. Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration.

AIM

To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures.

METHODS

A retrospective chart review at BronxCare Health System, New York, from January 2019 to October 2023, assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures. Two groups were compared based on dietary status before the procedure. Data included demographics, symptoms of gastroparesis, opiate use, hemoglobin A1c, GLP-1 agonist indication, endoscopic details, and aspiration occurrence. IBM SPSS was used for analysis, calculating means, standard deviations, and applying Pearson’s chi-square and t-tests for associations, with P < 0.05 as being significant.

RESULTS

During the study, 306 patients were included, with 41.2% on a clear liquid/low residue diet and 58.8% on a regular diet before endoscopy. Most patients (63.1%) were male, with a mean age of 60 ± 12 years. The majority (85.6%) were on GLP-1 RAs for diabetes, and 10.1% reported digestive symptoms before endoscopy. Among those on a clear liquid diet, 1.5% had residual food at endoscopy compared to 10% on a regular diet, which was statistically significant (P = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications were reported during or after the procedures.

CONCLUSION

The study reflects a significant rise in GLP-1 RA use for diabetes and obesity. A 24-hour liquid diet seems safe for endoscopic procedures without aspiration. Patients with upper gastrointestinal symptoms might have a higher residual food risk, though not statistically significant. Further research is needed to assess risks based on diabetes duration, gastroparesis, and GLP-1 RA dosing, aiming to minimize interruptions in therapy during procedures.

Keywords: Glucagon-like peptide-1 agonists; Gastroparesis; Endoscopic procedures; Residual food; Complications

Core Tip: This retrospective study assessed the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RA) on gastric residual contents during endoscopy. Patients on a clear liquid diet had significantly lower residual food rates (1.5%) compared to those on a regular diet (10%, P = 0.03). Among patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications occurred during or after the procedures. The study suggests that a 24-hour liquid diet is safe for endoscopic procedures. However, further research is needed to understand residual food risks in patients with upper gastrointestinal symptoms and to evaluate risks based on diabetes duration, gastroparesis presence, and GLP-1 RA dosing.