胰高血糖素样肽-1受体激动剂的使用与接受胃肠内镜检查患者的残余胃内容物及误吸风险：一项系统评价和荟萃分析

Glucagon-like peptide-1 receptor agonist use and the risk of residual gastric contents and aspiration in patients undergoing GI endoscopy: a systematic review and a meta-analysis.

作者信息

Baig Muhammad Usman, Piazza Allison, Lahooti Ali, Johnson Kate Elise, Rangwani Sean, Gouda Zane, Mahadev Srihari, Newberry Carolyn, Hanscom Mark, Sampath Kartik, Kumar Sonal, Anca Diana, Schulman Allison Raye, Carr-Locke David Leslie, Sharaiha Reem Z

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA.

Samuel J. Wood Library, Weill Cornell Medicine, New York, New York, USA.

出版信息

Gastrointest Endosc. 2025 Apr;101(4):762-771.e13. doi: 10.1016/j.gie.2024.12.019. Epub 2024 Dec 16.

DOI:10.1016/j.gie.2024.12.019

PMID:39694296

Abstract

BACKGROUND AND AIMS

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used for type 2 diabetes mellitus and obesity, but safety concerns have been raised for users undergoing GI endoscopy because of retained food and aspiration events. We compared the risk of adverse events for GLP-1RA users and nonusers undergoing endoscopy.

METHODS

We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42024556732). A systematic search in PubMed, Scopus, Web of Science, and Cochrane Central was performed from their inception until July 1, 2024 (EMBASE from 1974 to June 28, 2024). Double-arm adult human original studies (observational, randomized controlled trial) with a sample size of ≥20 undergoing EGD or endoscopy with no GLP-1RA use in the control arm were searched. Studies were excluded if they were single arm and had any use of GLP-1RA before the procedure in the control arm. Residual gastric contents (RGCs), aspiration pneumonia, and premature endoscopy termination were the main outcomes. The random-effects model was used to pool and get final effect estimates.

RESULTS

Twenty-three observational studies were selected consisting of 262,018 patients. GLP-1RA users had a statistically significant increase in the risk of RGCs (odds ratio [OR], 4.54; 95% confidence interval [CI], 3.30-6.24; P < .00001, I = 68%) and premature endoscopy termination (OR, 4.54; 95% CI, 3.05-6.75; P < .00001, I = 0%). There was no significant difference in the risk of aspiration pneumonia (OR, .96; 95% CI, .53-1.75; P = .90, I = 70%). A significant reduction was seen in RGCs when EGD and colonoscopy (OR, .28; 95% CI, .22-.36; P < .00001, I = 0%) were done the same day versus EGD alone.

CONCLUSIONS

GLP-1RA use was associated with an increased risk of RGCs and premature endoscopy termination, but no significant difference was found in the risk of aspiration pneumonia in patients undergoing endoscopy.

摘要

背景与目的

胰高血糖素样肽-1受体激动剂（GLP-1RAs）用于治疗2型糖尿病和肥胖症，但由于内镜检查时存在食物残留和误吸事件，接受胃肠内镜检查的使用者对此存在安全担忧。我们比较了接受内镜检查的GLP-1RA使用者和非使用者发生不良事件的风险。

方法

我们进行了一项系统评价和荟萃分析（PROSPERO注册号：CRD42024556732）。从各数据库建库至2024年7月1日（EMBASE为1974年至2024年6月28日），在PubMed、Scopus、Web of Science和Cochrane Central进行了系统检索。检索样本量≥20例、双臂的成人原始研究（观察性研究、随机对照试验），这些研究进行了上消化道内镜检查（EGD）或内镜检查，且对照组未使用GLP-1RA。如果研究为单臂研究或对照组在检查前曾使用过GLP-1RA，则将其排除。主要结局为残余胃内容物（RGCs）、误吸性肺炎和内镜检查提前终止。采用随机效应模型进行汇总并获得最终效应估计值。

结果

共纳入23项观察性研究，包括262,018例患者。GLP-1RA使用者发生RGCs的风险有统计学显著增加（比值比[OR]，4.54；95%置信区间[CI]，3.30 - 6.24；P <.00001，I² = 68%）以及内镜检查提前终止的风险增加（OR，4.54；95% CI，3.05 - 6.75；P <.00001，I² = 0%）。误吸性肺炎的风险无显著差异（OR，0.96；95% CI，0.53 - 1.75；P = 0.90，I² = 70%）。与单独进行EGD相比，同一天进行EGD和结肠镜检查时RGCs显著减少（OR，0.28；95% CI，0.22 - 0.36；P <.00001，I² = 0%）。