Intro: Glucagon-like peptide 1 (GLP-1) agonists are incretin mimetics that bind to GLP-1 receptors to stimulate glucose-dependent insulin release from pancreatic islet cells, inhibit postprandial glucagon level spikes, and suppress appetite by slowing gastric emptying. Currently, the literature has not described the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) complications in type 2 diabetic patients (T2DM) patients. This study aims to assess the risk of post-ERCP complications in T2DM patients on GLP-1 agonists.

Methods: A retrospective cohort study was conducted using TriNetX, a multi-center database of ~110 million patients across 80 healthcare organizations. T2DM Adult patients who underwent an ERCP were identified from 2006-2022 and then split into those with and without 1 1-year history of GLP-1 Agonists. 1:1 propensity score matching was performed, controlling for demographics and comorbidities, to assess 30-day adjusted risk ratios (aRR) for post-ERCP complications which included any episode of gastrointestinal (GI) bleed, post-ercp pancreatitis (PEP), GI perforation, acute kidney injury (AKI), intensive care unit (ICU) admission, sepsis, and all-cause mortality. Patients with prior history of bariatric surgery, DPP-4 inhibitor use and any occurrence of an assessed outcome prior to the study window were excluded from analysis.

Results: Among 32,866 T2DM patients who underwent ERCP, 2.9% had a 1-year history of GLP-1 agonist use. A matched cohort of 965 patients revealed Type 2 Diabetics on GLP-1 agonists had a significantly higher risk of PEP (aRR[95%CI]=1.49[1.2,2.1]) and a significantly lower risk of GI Bleeds (0.57[0.4,0.9]) and mortality (0.59[0.4,0.9]). No differences were seen in GI Perforation (0.99[0.4,2.4]), ICU admission (0.97[0.63,1.5]) or sepsis (0.89[0.6,1.3]).

Conclusion: This study reveals that GLP-1 agonists increase the risk of PEP in T2DM patients. Although it confers some protective effects, potentially holding off GLP-1 therapy prior to procedure may prove beneficial for patients with baseline comorbidities that place them at high risk for pancreatitis. Further studies are warranted to validate these findings.

Rahul Raiker

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