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
Division of Gastroenterology, Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, United States.
Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, United States.
World J Gastroenterol. 2024 Jul 14;30(26):3221-3228. doi: 10.3748/wjg.v30.i26.3221.
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.
To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures.
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 < 0.05 as being significant.
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 ( = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group ( = 0.130). No complications were reported during or after the procedures.
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.
胰高血糖素样肽-1受体激动剂（GLP-1 RA）对糖尿病和肥胖有效，通过增加胰岛素释放和延缓胃排空来降低高血糖。然而，它们可导致胃轻瘫，引发对手术过程中误吸的担忧。近期指南建议在手术前停用GLP-1 RA以降低肺误吸风险。
评估GLP-1 RA在内镜检查过程中对胃残余物的影响。
对纽约布朗克斯医疗系统2019年1月至2023年10月期间进行的回顾性病历审查，评估接受内镜检查的GLP-1 RA患者的胃残余物和误吸情况。根据检查前的饮食状况比较两组。数据包括人口统计学、胃轻瘫症状、阿片类药物使用情况、糖化血红蛋白、GLP-1激动剂适应证、内镜检查细节和误吸发生情况。使用IBM SPSS进行分析，计算均值、标准差，并应用Pearson卡方检验和t检验分析相关性，P<0.05为有统计学意义。
研究期间纳入306例患者，内镜检查前41.2%为清流食/低渣饮食，58.8%为常规饮食。大多数患者（63.1%）为男性，平均年龄60±12岁。大多数（85.6%）因糖尿病使用GLP-1 RA，10.1%在内镜检查前报告有消化系统症状。清流食组中，1.5%在内镜检查时有残余食物，常规饮食组为10%，差异有统计学意义（P = 0.03）。在31例有消化系统症状的患者中，13%有残余食物，均来自常规饮食组（P = 0.130）。检查期间及检查后均未报告并发症。
该研究反映了GLP-1 RA在糖尿病和肥胖治疗中的使用显著增加。24小时流食饮食似乎对内镜检查安全，不会发生误吸。有上消化道症状的患者可能有更高的残余食物风险，尽管无统计学意义。需要进一步研究根据糖尿病病程、胃轻瘫和GLP-1 RA剂量评估风险，以尽量减少检查过程中治疗的中断。
