Post written by Ramzi Mulki, MD, from the University of Alabama at Birmingham, Birmingham, Alabama, USA.

This study focused on evaluating the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on gastric mucosal visibility and retained contents during EGD. Specifically, it investigated whether GLP-1RAs use affects visibility scores (with validated scores) and retained contents, which could lead to aborted procedures and adverse events.

This study is important because it addresses a clinically relevant issue for gastroenterologists, anesthesiologists, and patients using GLP-1RAs. With the ongoing obesity epidemic, we are seeing more patients presenting for their EGD procedure who are prescribed GLP-1RAs for management of obesity and diabetes. GLP-1RAs have been shown to delay gastric emptying, which may negatively impact visibility, lead to higher rates of retained gastric contents, and result in adverse events, such as pulmonary aspiration, potentially affecting safety, diagnostic accuracy, and procedural efficiency. 

This study was a 1:1 matched case-control study of 84 pairs (N = 168) comparing individuals who were taking GLP-1RAs with nonusers. Matching was based on demographic characteristics and diabetes status. We used a validated scale (POLPREP) to determine gastric mucosal visibility scores.

We found that GLP-1RA users were more likely to have lower visibility scores, higher retained contents (13.1% vs 4.8%), and a higher rate of aborted procedures because of this issue. Interestingly, there were no anesthesia-related adverse events, such as pulmonary aspiration. There are limited data to guide the perioperative care of patients on GLP-1RAs.

Therefore, this study adds to the ongoing growth of the body of literature to allow for more informed guidelines and recommendations. Future prospective studies are needed to confirm our findings and to evaluate factors that may mitigate these effects.   

Graphical abstract

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