Phan Jennifer, Chang Patrick, Issa Danny, Turner Ronald, Dodge Jennifer, Westanmo Anders, Karna Rahul, Olive Lorenzo, Bahdi Firas, Aldzhyan Vahagn, Bilal Mohammad, Tielleman Thomas
Keck Hospital of USC, Los Angeles, California, USA.
University of California Los Angeles, Los Angeles, California, USA.
Am J Gastroenterol. 2025 Mar 1;120(3):554-561. doi: 10.14309/ajg.0000000000002969. Epub 2024 Jul 17.
While ubiquity of glucagon-like peptide receptor agonists (GLP1-RAs) is rising, guidance from the gastroenterology societies and American Society of Anesthesiologist (ASA) remains in conflict on recommendations regarding preoperative holding before endoscopy. The aim of this study was to address this by evaluating the effect of GLP1-RAs on gastric retention during upper endoscopy.
This multicenter cross-sectional study included patients on confirmed GLP1-RAs receiving an endoscopy from 2021 to 2023. Demographics, prescribing practices, and procedure outcomes were captured. GLP1-RA management of preoperative holding was retroactively classified per ASA guidance. Multivariable logistic regression was performed to assess factors influencing retained gastric contents.
Of 815 patients, 70 (8.7%) had retained gastric contents on endoscopy of whom 65 (93%) had type 2 diabetes mellitus. Only 1 (1.4%) of these patients required unplanned intubation, and none had aspiration events. Those with GLP1-RA held per ASA guidance (406, 49.8%) were less likely to have retained contents (4.4% vs 12.7%, P < 0.001), but there were no significant differences to intubation (0% vs 2%, P = 0.53) or aborting procedure rates (28% vs 18%, P = 0.40) due to gastric retention. On multivariable analysis, likelihood of food retention increased 36% (95% confidence interval 1.15-1.60) for every 1% increase in hemoglobin A1C after adjusting for GLP1-RA type and preoperative medication hold.
In this multicenter study, very low rates of retained gastric contents were seen during endoscopy in patients on GLP1-RAs and most were in patients with type 2 diabetes mellitus. Our findings suggest an individualized approach rather than universal preoperative holding of medications before endoscopy.
虽然胰高血糖素样肽受体激动剂（GLP1-RAs）的使用越来越普遍，但胃肠病学会和美国麻醉医师协会（ASA）在关于内镜检查前术前停药的建议上仍存在冲突。本研究的目的是通过评估GLP1-RAs对上消化道内镜检查期间胃潴留的影响来解决这一问题。
这项多中心横断面研究纳入了2021年至2023年期间接受内镜检查且确诊使用GLP1-RAs的患者。收集了人口统计学、处方习惯和手术结果。根据ASA指南对术前停药的GLP1-RA管理进行追溯分类。进行多变量逻辑回归以评估影响胃内容物潴留的因素。
在815例患者中，70例（8.7%）在内镜检查时有胃内容物潴留，其中65例（93%）患有2型糖尿病。这些患者中只有1例（1.4%）需要进行非计划插管，且无一例发生误吸事件。按照ASA指南停用GLP1-RA的患者（406例，49.8%）胃内容物潴留的可能性较小（4.4%对12.7%，P<0.001），但因胃潴留导致的插管率（0%对2%，P=0.53）或手术中止率（28%对18%，P=0.40）无显著差异。在多变量分析中，在调整GLP1-RA类型和术前药物停用情况后，糖化血红蛋白每增加1%，食物潴留的可能性增加36%（95%置信区间1.15-1.60）。
在这项多中心研究中，使用GLP1-RAs的患者在内镜检查期间胃内容物潴留的发生率非常低，且大多数患者患有2型糖尿病。我们的研究结果表明，在内镜检查前应采取个体化方法，而不是普遍进行术前停药。
