Background:
Glucagon-like peptide-1 agonists (GLP-1), used in treating type 2 diabetes and Obesity, are linked to gastrointestinal side effects like nausea and delayed gastric emptying, increasing the risk of peri-procedural aspiration. The American Society of Anesthesiologists (ASA) recently outlined recommendations on the duration of mandated cessation of GLP-1 agents before sedation or usage of “full stomach” precautions if these medications were not appropriately held before the procedure. No real-world- data is available on the risks of aspiration pneumonitis or the need for emergent intubation in patients taking GLP-1 agonists during or immediately after esophagogastroduodenoscopy (EGD) and Colonoscopy (Colon). We aimed to compare the incidence of aspiration pneumonitis and emergent intubation following EGDs and Colons in patients taking GLP-1 agonists versus those not taking GLP-1 agonists.

Methods:
A retrospective cohort study was done using TriNetX, a federated cloud-based network research database comprising multiple US healthcare organizations (HCOs). We divided the patients into 2 groups: Patients on GLP-1 (Liraglutide, Semaglutide, Dulaglutide, Exenatide, and Lixisenatide), GLP-1/Glucose-dependent insulinotropic polypeptide (Tirzepatide) and patients who were not on these medications, who underwent EGDs and Colons. The procedures were selected based on the CPT codes, and medication use was identified using RxNorm data. Propensity score matching for age, sex, and ethnicity was performed between the two groups to balance and remove confounders. The outcomes assessed were the incidence of aspiration pneumonitis and the need for emergent endotracheal intubation post-procedure.

Results:
Analysis of risk of pneumonitis, patients (n) in each cohort (events in parenthesis) were as follows: For EGDs, GLP-1 cohort: n=61,355 (38); non-GLP1 cohort n=61,291 (68), the pneumonitis risk was slightly higher in the non-GLP cohort compared with the GLP-1 cohort but did not reach statistical significance (p=0.136). For Colons, there was no difference in the risk of pneumonitis [GLP-1 cohort: n=78,153 (13); Non-GLP cohort n=78,456 (12) (p=0.511)].
Intubation risk was also slightly higher [GLP-1 cohort: n=56, 907 (85); Non-GLP cohort n=56,882 (173)] in the non-GLP cohort compared with the GLP-1 cohort (3/1000 vs 1/1000) but did not reach statistical significance (p=0.159). For Colons, the intubation risk between the groups was similar [GLP-1 cohort: n=78,212 (13); Non-GLP cohort n=78,471 (14) (p=0.159)].

Conclusion:
Contrary to initial concerns, our study shows that GLP-1 agonists do not increase the risk of aspiration pneumonitis or the need for emergent intubation in patients who undergo endoscopic procedures. Further randomized trials are warranted to evaluate the incidence of such outcomes and evidence-based peri-procedural usage of these medications.

Figure 1: Baseline characteristics of patients who underwent colonoscopies<br /> Purple: GLP-1, Green: Non-GLP

Figure 1: Baseline characteristics of patients who underwent colonoscopies
Purple: GLP-1, Green: Non-GLP

Figure 1: Baseline characteristics of patients who underwent EGDs<br /> Purple: GLP-1, Green: Non-GLP

Figure 1: Baseline characteristics of patients who underwent EGDs
Purple: GLP-1, Green: Non-GLP

John Joyce

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