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TOPLINE: 

Encountering retained gastric contents during esophagogastroduodenoscopy (EGD) is more common in patients taking glucagon-like peptide 1 receptor agonists (GLP-1 RAs) but rarely leads to procedure abortion or aspiration, new data from the Cleveland Clinic showed. 

METHODOLOGY: 

• Currently, recommendations on how to handle EGD in patients taking GLP-1 RAs for type 2 diabetes or obesity vary, due largely to a lack of outcomes data from which to draw evidence-based conclusions. 
• Researchers performed a retrospective analysis of 1512 index EGDs performed on patients taking GLP-1 RAs.
• Data were extracted using a combination of diagnosis codes, procedure codes, and natural language processing and refined by manual chart review.
• The primary outcome was the rate of retained gastric contents encountered during EGD. The secondary outcomes included rates of aborted procedures, repeat procedures, and adverse events, with a focus on aspiration.

• Of the 1512 EGDs included, 142 (9.4%) had retained gastric contents, primarily solid residue (78.9%). The prevalence of retained gastric contents was higher (11.6%) in the EGDs performed to evaluate upper gastrointestinal symptoms. 
• Endoscopy was aborted in 30 cases (2.0%); 29 had retained gastric contents. Many also required repeat EGD. 
• Despite the high rate of retained gastric contents, aspiration risk remained low (two cases; 0.1%) — only marginally higher than the rate among the general population. Other adverse events included four cases (0.3%) of intraprocedural hypoxia and one each of abdominal pain, bronchospasm, and cholangitis, which were all categorized as mild.
• On multivariate analysis, younger age was associated with a higher risk for retained gastric contents.

IN PRACTICE: 

The authors wrote that their observations support "the [American Gastroenterological Association] recommendation endorsing a liquid diet the day before endoscopy in lieu of holding [GLP-1 RAs]." 

SOURCE:

The study, with first author Stephen A. Firkins, MD, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Ohio, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

The authors did not state any specific limitations.

DISCLOSURES:

The study had no specific funding. The authors disclosed no conflicts of interest.