S751 An Institutional Review of Upper Endoscopy Outcomes in Patients Taking Glucagon-Like Peptide-1 Receptor (Glp-1) Agonists: No Increased Risk of Aspiration or Retained Gastric Contents

Introduction: The safety of glucagon-like peptide-1 (GLP-1) receptor agonists in the peri-procedural setting has become an area of concern, particularly regarding risk of aspiration and retained gastric contents (RGC). In June 2023, the American Society of Anesthesiologists (ASA) released new guidance for management of GLP-1 agonists prior to endoscopy. Case reports have documented aspiration events during endoscopy, but robust evidence evaluating risk in patients on GLP-1 agonists is lacking. This study aimed to assess the risks of aspiration and RGC in patients on GLP-1 agonists undergoing endoscopy at an academic medical center. Methods: This observational study included 154 patients (control N = 103; GLP-1 N = 51) who underwent outpatient upper endoscopy between May-December 2023. Patients included in the GLP-1 arm had a prescription for a GLP-1 agonist prior to upper endoscopy. The primary endpoint was aspiration. RGC was a secondary outcome. The Yates' Chi-Square test was used to compare the incidence of aspiration and RGC between groups. A significance level of P < 0.05 was used for analysis. Results: There were no documented cases of aspiration in the 154-patient cohort. Three patients had RGC in the GLP-1 group and no patients had RGC in the control group. The P-value was 0.061, which was not significant at the P < 0.05 level. In the GLP-1 group, the majority of patients were diabetic (N = 45, 88.2%), women (N = 31, 60.8%), Black (N = 25, 49.0%) and had same-day colonoscopy (N = 33, 64.7%). Only 14% (N = 15/103) of patients in the control group had diabetes mellitus, a notable difference from the 88.2% with diabetes in the GLP-1 group. Despite the difference, average HbA1c was 6.1% in both groups. Conclusion: Our finding of no aspiration events in either group was expected and consistent with prior studies reporting aspiration as a rare outcome of upper endoscopy. The small number of GLP-1 patients who had RGC was not statistically significant compared to the control group. Our results are limited by small sample size, but the overall lack of significant or minor events is consistent with other studies. Given the limited risk of holding the medication, attempts should be made to comply with holding parameters set out in ASA guidelines. However, given the infrequency of aspiration or even RGC, failure to hold GLP-1 medications, per ASA guidelines, should not automatically preclude urgent or emergent procedures.