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Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study

Association d’un traitement par agonistes des récepteurs du peptide-1 de type glucagon avec la présence de contenu gastrique chez des personnes à jeun bénéficiant d’une endoscopie sous anesthésie : une étude de cohorte historique

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Abstract

Purpose

We aimed to estimate the association of glucagon-like peptide 1 (GLP-1) receptor agonist therapy with the incidence of endoscopically visible gastric contents after preprocedural fasting.

Methods

We reviewed the records of esophagogastroduodenoscopy (EGD) performed at our institution between 2019 and 2023 and determined the presence of residual gastric contents from the procedure notes and saved images. We compared patients taking GLP-1 agonists at the time of the procedure (GLP group, 90 procedures) with patients who started GLP-1 agonist therapy within 1,000 days after undergoing EGD (control, 102 procedures). We excluded emergent procedures without fasting, combined EGD/colonoscopy procedures, and patients with known gastroparesis or previous gastric surgery. We estimated the association between GLP-1 agonist therapy and residual gastric contents with a confounder-adjusted generalized linear mixed effect model.

Results

Compared with controls, the GLP cohort had a higher age, American Society of Anesthesiologists’ Physical Status, and incidence of nausea and diabetes mellitus. Body mass index and fasting duration were comparable between groups. Visible gastric content was documented in 17 procedures in the GLP group (19%) and in five procedures in the control group (5%), with an associated confounder adjusted odds ratio of 5.8 (95% confidence interval, 1.7 to 19.3; P = 0.004). There were five instances of emergent endotracheal intubation in the GLP group vs one case in control and one case of pulmonary aspiration vs none in control.

Conclusions

In fasting patients, GLP-1 agonist therapy was associated with an increased incidence of residual gastric contents, potentially posing an additional risk of periprocedural pulmonary aspiration.

Résumé

Objectif

Notre objectif était d’estimer l’association d’un traitement par agonistes des récepteurs du peptide-1 de type glucagon (glucagon-like peptide 1, GLP-1) avec l’incidence de contenu gastrique visible par endoscopie malgré le jeûne préopératoire.

Méthode

Nous avons examiné les dossiers des œsophagogastroduodénoscopies (OGD) réalisées dans notre établissement entre 2019 et 2023 et déterminé la présence de contenu gastrique résiduel à partir des notes d’intervention et des images enregistrées. Nous avons comparé les patient·es prenant des agonistes du GLP-1 au moment de l’intervention (groupe GLP, 90 procédures) avec les patient·es qui ont commencé un traitement par agonistes du GLP-1 dans les 1000 jours suivant l’OGD (groupe témoin, 102 procédures). Nous avons exclu les procédures d’urgence sans jeûne, les procédures combinées OGD/coloscopie et les patient·es présentant une gastroparésie connue ou une chirurgie gastrique antérieure. Nous avons estimé l’association entre le traitement par agonistes du récepteur GLP-1 et le contenu gastrique résiduel à l’aide d’un modèle linéaire généralisé à effets mixtes ajusté en fonction des facteurs de confusion.

Résultats

Par rapport aux témoins, la cohorte GLP était plus âgée, de statut physique selon l’American Society of Anesthesiologists plus élevé et présentait une incidence plus élevée de nausées et de diabète. L’indice de masse corporelle et la durée du jeûne étaient comparables entre les groupes. Du contenu gastrique visible a été documenté dans 17 procédures dans le groupe GLP (19 %) et dans cinq procédures dans le groupe témoin (5 %), avec un rapport de cotes ajusté associé de 5,8 (intervalle de confiance à 95 %, 1,7 à 19,3; P = 0,004). Il y a eu cinq cas d’intubation endotrachéale urgente dans le groupe GLP vs un cas dans le groupe témoin et un cas d’aspiration pulmonaire vs aucun dans le groupe témoin.

Conclusion

Chez la patientèle à jeun, le traitement par agonistes des récepteurs du GLP-1 a été associé à une incidence accrue de contenu gastrique résiduel, ce qui pourrait entraîner un risque supplémentaire d’aspiration pulmonaire périprocédurale.

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Author contributions

Ion A. Hobai, Fei Wu, and Braden Kuo contributed to the study conception and design. Ion A. Hobai, Fei Wu, Matthew R. Smith, Ariel L. Mueller, Seth A. Klapman, and Lucinda L. Everett contributed to data acquisition. Ion A. Hobai, Fei Wu, Matthew R. Smith, Ariel L. Mueller, Timothy Houle, and Braden Kuo contributed to data analysis and interpretation. Ion Hobai contributed to drafting the article. All authors contributed to the article revision.

Disclosures

None.

Funding statement

Departmental only.

Editorial responsibility

This submission was handled by Dr. Vishal Uppal, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Fei Wu MBBS, Matthew R. Smith BA, Ariel L. Mueller MA, Seth A. Klapman MD, MBA, Lucinda L. Everett MD & Timothy Houle PhD

  2. Division of Gastroenterology, Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA

    Braden Kuo MD

  3. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Str., GRB 444, Boston, MA, 02114, USA

    Ion A. Hobai MD, PhD

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  1. Fei Wu MBBS
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Correspondence to Ion A. Hobai MD, PhD.

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Wu, F., Smith, M.R., Mueller, A.L. et al. Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study. Can J Anesth/J Can Anesth (2024). https://doi.org/10.1007/s12630-024-02719-z

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