Glucagon-like peptide-1 receptor agonist use and the risk of residual gastric content and aspiration in patients undergoing gastrointestinal endoscopy: a systematic review and a meta-analysis.
Review
Overview
abstract
BACKGROUND: GLP-1 receptor agonists are used for type 2 diabetes mellitus and obesity, but safety concerns have been raised for users undergoing gastrointestinal endoscopy, regarding retained food and aspiration events. AIMS: We aim to compare the risk of complications for GLP-1 users and non-users 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 1st July, 2024 (Embase from 1974 to 28th June, 2024). Double-arm human adult original studies (observational, RCT) with a sample size of 20 or more undergoing EGD or endoscopy with no GLP-1 RA use in the control arm were searched. Studies were excluded if they were single-arm and had any use of GLP-1 before the procedure in the control arm. Residual gastric contents (RGC), aspiration pneumonia, and premature endoscopy termination were the main outcomes. The random-effects model was used to pool and get final effect estimates. RESULTS: 23 observational studies were selected consisting of 262,018 patients. GLP1 RA users had a statistically significant increase in the risk of RGC (OR 4.54, 95% CI 3.30-6.24, p<0.00001, I2= 68%) and premature endoscopy termination (OR 4.54, 95% CI 3.05-6.75, p<0.00001, I2= 0%). There was no significant difference in the risk of aspiration pneumonia (OR 0.96, 95% CI 0.53-1.75, p=0.90, I2= 70%). A significant reduction was seen in RGC when EGD & colonoscopy (OR= 0.28 [0.22, 0.36], p<0.00001; I2= 0%) were done the same day vs EGD alone (Figure 1 Graphical abstract). CONCLUSIONS: GLP-1 RA use was associated with an increased risk of RGC and premature endoscopy termination, but no significant difference was found in the risk of aspiration pneumonia patients undergoing endoscopy.
