Holding GLP1-RAs before endoscopy ‘is justified’ to reduce risk for aspiration pneumonia

Key takeaways:

• Glucagon-like peptide-1 receptor agonists were associated with a higher risk for aspiration pneumonia after endoscopy.
• Risk also was higher with propofol sedation and upper or combined upper/lower endoscopy.

Glucagon-like peptide-1 receptor agonists were linked to a significantly higher risk for aspiration pneumonia after gastrointestinal endoscopy, particularly among those undergoing upper endoscopy and propofol sedation, according to a study.

“The American Society of Anesthesiologists recently released a consensus-based guideline recommending holding GLP-1RAs before an endoscopic or surgical procedure to decrease the risk of aspiration,” Yee Hui Yeo, MD, a resident in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai Medical Center in Los Angeles, and colleagues wrote in Gastroenterology. “Subsequently, the AGA released a clinical practice update that found insufficient evidence to stop GLP-1RAs before endoscopic procedures and recommended an individualized approach for these patients.”

They added, “Both societies acknowledged the paucity of data to provide firm recommendations.”

In a population-based, retrospective cohort study, Yeo and colleagues investigated the incidence and risk for aspiration pneumonia using health record data from 963,184 adults aged 21 to 70 years who underwent endoscopy between 2018 and 2020. Researchers compared outcomes among those who received glucagon-like peptide-1 receptor agonists (GLP1-RAs) vs. those who did not.

A cohort of 20,099 GLP1-RA users (mean age, 55.4 years; 56.6% women) and 778,253 non-users (mean age, 50.8 years; 52% women) met the study’s inclusion criteria and were matched for potential confounders using propensity score matching (n = 15,908 per group).

According to study results, GLP1-RA use was associated with a higher incidence rate (0.83% vs. 0.63%), as well as a “significantly higher risk” for aspiration pneumonia (HR = 1.33; 95% CI, 1.02-1.74) compared with non-users.

Researchers also reported an elevated risk among patients who had propofol-assisted endoscopies (HR = 1.49; 95% CI, 1.08-2.06) vs. those who did not (HR = 1.31; 95% CI, 0.78-2.2) and among those who underwent upper endoscopy (HR = 1.82; 95% CI, 1.27-2.6) or combined upper and lower endoscopy (HR = 2.26; 95% CI, 1.23-4.16) vs. lower endoscopy (HR = 0.56; 95% CI, 0.25-1.27).

“Holding GLP-1RAs before endoscopy may disrupt diabetes management and increase procedure cancellations, yet our findings suggest this practice is justified by the increased, albeit modest, risk of aspiration, especially in upper GI and propofol-assisted procedures,” Yeo and colleagues wrote. “Furthermore, the complex pharmacokinetics of GLP-1RAs, with uncertain timelines for gastric emptying normalization, necessitates further investigation to establish optimal drug withholding periods before endoscopies.”

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