Ho Cindy N, Ayers Alessandra T, Kohn Michael A, Umpierrez Guillermo E, Klonoff David C
Diabetes Technology Society, Burlingame, CA 94010, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, USA.
J Endocr Soc. 2025 Jul 10;9(9):bvaf088. doi: 10.1210/jendso/bvaf088. eCollection 2025 Sep.
Delayed gastric emptying caused by glucagon-like peptide-1 receptor agonists (GLP-1RAs) has raised concerns about increased aspiration risk during surgical and endoscopic procedures. In June 2023, the American Society of Anesthesiologists (ASA) recommended discontinuing GLP-1RAs one day (daily users) or one week (weekly users) before elective surgery or endoscopic esophagogastroduodenoscopy (EGD). In October 2024, the ASA reversed the initial recommendation and advised most patients to continue taking GLP-1RAs before elective surgery.
We conducted a systematic review of the evidence for or against the original recommendation.
We searched PubMed for retrospective cohort studies published between June 2023 and March 2025 investigating the association between GLP-1RA use and the risk of aspiration/pneumonia in patients undergoing elective surgery or endoscopic procedures. We calculated a summary risk ratio for studies that could be combined.
We identified 3 studies of elective surgery and 4 of EGD using large databases to identify an increased risk of aspiration/pneumonia associated with GLP-1RA use. The 3 elective surgery studies had a combined risk ratio of 1.00 [0.76, 1.30]. The 4 EGD studies had a combined risk ratio of 1.10 [0.95, 1.27]. In one study, a parallel analysis of the aspiration/pneumonia risk associated with opioid medications found a risk ratio of 2.68 [1.89, 3.81], indicating that the methodology could detect an increased risk of aspiration/pneumonia from a motility inhibitor.
Although GLP-1RAs cause delayed gastric emptying, retrospective cohort studies using large real-world evidence databases have not consistently identified a GLP-1RA-associated risk of aspiration/pneumonia for elective surgical and endoscopic procedures.
胰高血糖素样肽-1受体激动剂（GLP-1RAs）导致的胃排空延迟引发了人们对手术和内镜检查过程中误吸风险增加的担忧。2023年6月，美国麻醉医师协会（ASA）建议在择期手术或内镜食管胃十二指肠镜检查（EGD）前一天（每日使用者）或一周（每周使用者）停用GLP-1RAs。2024年10月，ASA推翻了最初的建议，并建议大多数患者在择期手术前继续服用GLP-1RAs。
我们对支持或反对原建议的证据进行了系统评价。
我们在PubMed上搜索了2023年6月至2025年3月发表的回顾性队列研究，这些研究调查了GLP-1RA使用与接受择期手术或内镜检查患者的误吸/肺炎风险之间的关联。我们计算了可合并研究的汇总风险比。
我们确定了3项关于择期手术的研究和4项关于EGD的研究，这些研究使用大型数据库发现GLP-1RA使用与误吸/肺炎风险增加有关。3项择期手术研究的合并风险比为1.00[0.76,1.30]。4项EGD研究的合并风险比为1.10[0.95,1.27]。在一项研究中，对与阿片类药物相关的误吸/肺炎风险进行的平行分析发现风险比为2.68[1.89,3.81]，这表明该方法能够检测到动力抑制剂导致的误吸/肺炎风险增加。
尽管GLP-1RAs会导致胃排空延迟，但使用大型真实世界证据数据库的回顾性队列研究并未一致发现GLP-1RA与择期手术和内镜检查的误吸/肺炎风险相关。
