P5113 - Peri-Operative Use of Glucagon-Like Peptide 1 (GLP-1) Agonists Is Associated with Retained Gastric Contents During Upper Endoscopy and Procedure Abortion, but Not With Procedural Complications

Ricardo Flores, Jr., BSc¹, Prachi J. Shah, BS², Inaya Spradley, BS³, Katherine Gilpin, MPH⁴, Dev V. Sharma, ⁵, Andrew Fu, BS⁶, Tenzin s. Oshoe, BS¹, Matthew Pelowski, BS¹, Anuj Gupta, BA¹, Jonathan Steinberg, MD, MA¹, Joseph LaComb, BSc¹, Ellen Li, MD, PhD¹, Lionel S.. D'Souza, MD⁷, Michael J. Clores, DO¹
1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY; 2Renaissance School of Medicine at Stony Brook University, New Hyde Park, NY; 3Renaissance School of Medicine at Stony Brook University, Coram, NY; 4Renaissance School of Medicine at Stony Brook University, Port Washington, NY; 5Renaissance School of Medicine at Stony Brook University, Commack, NY; 6Renaissance School of Medicine at Stony Brook University, Fresh Meadows, NY; 7Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Initial consensus-based guidance by the American Society of Anesthesiologists (AGA) recommended peri-operative interruption of glucagon-like peptide 1 (GLP-1) agonists in all patients receiving general anesthesia or deep sedation, including those undergoing upper endoscopy, given concerns for delayed gastric emptying and procedural complications. However, subsequent peer-reviewed literature prompted updated multi-society guidance, which suggests an individualized approach and shared-decision making. This study will add to the growing body of evidence regarding the procedural impact of peri-operative GLP-1 agonist use.

Methods: A large retrospective cohort study at a tertiary care safety-net hospital was performed on all adult patients undergoing elective outpatient upper endoscopy between November 2022 and October 2023. Patients with previous upper gastrointestinal surgeries and those with a history of prolonged mechanical ventilation were excluded. Patient demographics, clinical data and procedural outcomes were collected and a Fischer’s exact two-sided test was performed.

Results: 3,150 charts were reviewed and 2,215 patients were included in the study, 107 of whom had an active prescription for an oral or intramuscular GLP-1 agonist. GLP-1 agonist use was significantly associated with higher rates of both retained gastric contents (RR 3.93, CI 1.82 – 7.67; p = 0.004) and procedure abortion (RR 4.886, CI 1.71 – 10.98; p = 0.022). There were no cases of peri-operative aspiration or ensuing complications identified in any of the patients using GLP-1 agonists.

Discussion: While peri-operative GLP-1 use was associated with a nearly four-times greater risk of retained gastric contents and a nearly five-times greater rate of subsequent procedure abortion, this did not portend any increased risk of procedural complications, notably aspiration events. Furthermore, the overall number of cases with documented retained gastric contents was small. This data supports the more recent multi-society clinical guidance suggesting a more individualized patient approach toward GLP-1 agonist interruption prior to endoscopic procedures. Further studies will seek to standardize which patient and medication factors warrant peri-operative interruption of GLP-1 agonists to minimize procedural risk and help avoid unnecessary procedural cancellation or abortion.

Disclosures:
Ricardo Flores, Jr. indicated no relevant financial relationships.
Prachi Shah indicated no relevant financial relationships.
Inaya Spradley indicated no relevant financial relationships.
Katherine Gilpin indicated no relevant financial relationships.
Dev Sharma indicated no relevant financial relationships.
Andrew Fu indicated no relevant financial relationships.
Tenzin Oshoe indicated no relevant financial relationships.
Matthew Pelowski indicated no relevant financial relationships.
Anuj Gupta indicated no relevant financial relationships.
Jonathan Steinberg indicated no relevant financial relationships.
Joseph LaComb indicated no relevant financial relationships.
Ellen Li indicated no relevant financial relationships.
Lionel D'Souza: Boston Scientific – Consultant. Creo Medical – Consultant. Olympus America – Consultant.
Michael Clores indicated no relevant financial relationships.

Ricardo Flores, Jr., BSc¹, Prachi J. Shah, BS², Inaya Spradley, BS³, Katherine Gilpin, MPH⁴, Dev V. Sharma, ⁵, Andrew Fu, BS⁶, Tenzin s. Oshoe, BS¹, Matthew Pelowski, BS¹, Anuj Gupta, BA¹, Jonathan Steinberg, MD, MA¹, Joseph LaComb, BSc¹, Ellen Li, MD, PhD¹, Lionel S.. D'Souza, MD⁷, Michael J. Clores, DO¹. P5113 - Peri-Operative Use of Glucagon-Like Peptide 1 (GLP-1) Agonists Is Associated with Retained Gastric Contents During Upper Endoscopy and Procedure Abortion, but Not With Procedural Complications, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.