P0852 - Impact of GLP-1 Receptor Agonist Guidelines Change on Post-Endoscopic Complications: A Propensity-Matched Multi-Center Study

Harsimran Kalsi, MD¹, Mohammad Abu Assi, MD¹, Carson Creamer, DO², Kobina Essilfie-Quaye, MD², Yeshika Thapa, MD¹, Tony Brar, MD¹, Yaseen Perbtani, DO²
1University of Central Florida, Gainesville, FL; 2University of Central Florida, HCA Healthcare GME, Gainesville, FL

Introduction: American Society of Anesthesiologists (ASA) guidelines recommend withholding glucagon-like peptide-1 receptor agonists (GLP-1 RAs) prior to gastrointestinal endoscopy due to concerns of delayed gastric emptying and aspiration risk. However, supporting evidence remains limited. This study compares short-term complications among GLP-1 RA users before and after the adoption of these guidelines.

Methods: The TriNetX US Collaborative Network was queried for adults aged 21–70 years with type 2 diabetes, body‑mass index ≥ 30 kg/m², and ≥ 1 prescription for dulaglutide, liraglutide, or semaglutide ≥ 6 months before an endoscopic procedure. Bariatric‑surgery patients were excluded. Cohort A (post‑ASA guideline) comprised procedures from  June 28, 2023, to March 31, 2025; Cohort B (pre- ASA guideline) from September 1, 2021, to June 27, 2023. 1:1 nearest‑neighbor propensity‑score matching balanced 27 595 patients per cohort. Primary outcome was aspiration pneumonia; secondary outcomes were acute myocardial infarction (MI), cerebral infarction, ICU admission, acute respiratory failure, acute kidney injury (AKI), CPAP ventilation, and all‑cause mortality, captured within 7 days of the index procedure. Odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated.

Results: Event rates were low and did not differ significantly between periods. Aspiration pneumonia rates were nearly identical (0.11%; 29 events post-guideline vs. 30 pre-guideline; OR 0.97, 95% CI 0.58–1.61; p=0.90). Similarly, no differences were observed for acute myocardial infarction (0.28% vs. 0.32%; OR 0.85, 95% CI 0.63–1.16; p=0.31), cerebral infarction (0.41% vs. 0.39%; OR 1.05, 95% CI 0.80–1.36; p=0.74), ICU admission (0.42% vs. 0.39%; OR 1.09, 95% CI 0.84–1.42; p=0.50), acute respiratory failure (0.26% vs. 0.30%; OR 0.88, 95% CI 0.64–1.20; p=0.42), acute kidney injury (0.67% vs. 0.66%; OR 1.02, 95% CI 0.83–1.25; p=0.88), CPAP ventilation (0.27% vs. 0.23%; OR 1.16, 95% CI 0.83–1.62; p=0.39), or all-cause mortality (0.04% vs. 0.05%; OR 0.92, 95% CI 0.42–2.02; p=0.84). Kaplan-Meier survival analyses also revealed no significant differences.

Discussion: In this large matched GLP‑1 RA users, implementation of withholding guidance did not reduce aspiration or any other acute complication after endoscopy. Given the very low event rates and null associations, routine discontinuation of GLP‑1 RAs before endoscopy may be unnecessary in many patients; prospective studies are warranted to refine peri‑procedural recommendations.


Figure: Comparison of post-endoscopic complications within 7 days of procedure among GLP-1 receptor agonist users before and after ASA guideline.


Figure: Forest plot for post-endoscopic complications comparing post- ASA guideline versus pre- ASA guideline GLP-1 RA cohorts

Disclosures:
Harsimran Kalsi indicated no relevant financial relationships.
Mohammad Abu Assi indicated no relevant financial relationships.
Carson Creamer indicated no relevant financial relationships.
Kobina Essilfie-Quaye indicated no relevant financial relationships.
Yeshika Thapa indicated no relevant financial relationships.
Tony Brar indicated no relevant financial relationships.
Yaseen Perbtani indicated no relevant financial relationships.

Harsimran Kalsi, MD¹, Mohammad Abu Assi, MD¹, Carson Creamer, DO², Kobina Essilfie-Quaye, MD², Yeshika Thapa, MD¹, Tony Brar, MD¹, Yaseen Perbtani, DO². P0852 - Impact of GLP-1 Receptor Agonist Guidelines Change on Post-Endoscopic Complications: A Propensity-Matched Multi-Center Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.