S1268 Evaluating Glucagon-Like Peptide 1 Receptor Agonist Use and Retained Gastric Contents: Safety Implications for Upper Endoscopy

Introduction: Glucagon-like peptide 1 receptor agonist (GLP-1RA) use is increasingly common. These agents act on the gastrointestinal tract by delaying gastric emptying. GLP-1RA use increases the odds of having retained gastric contents on esophagogastroduodenoscopy (EGD) 2- to 9-fold, but there are mixed data regarding their effects on aspiration risk and procedure completion rates. We evaluated EGD records with and without retained gastric content to discern the risks of GLP-1RA use and confounding factors relevant to procedural completion and patient safety outcomes. Methods: This single-site retrospective case control study evaluated EGD procedures completed from 1/2014 – 12/2024. Participant demographics, fasting times, comorbid conditions, and medications that could contribute to delayed gastric emptying were collected from the electronic health record (EHR). Univariate analysis was performed to associate these factors with the presence of food on EGD, including the use of GLP-1RA medications. Multivariable regression was performed to measure the effect of GLP-1RA medications adjusting for other factors that may influence gastric emptying. Results: 42,964 procedures were identified from the electronic health record and 3,181 were excluded because the EGD was canceled, leaving 30,132 patients who underwent 39,783 EGDs. Mean age 52, BMI 29, female sex 60%, and fasting time of 20 hours. The majority of patients adhered to a fasting time >8 hours pre-EGD. 991 EGD exams had solid retained gastric content (2.4%). Out of 201 patients who used a GLP-1RA, 23 had retained gastric content on their EGD (11.4%, OR 5.2; adjusted OR 2.9). EGD exams with retained gastric content were associated with higher comorbid complexity (OR 1.2), diabetes (OR 2.5), or gastroparesis (OR 6.3). Procedural limitations and complications occurred at higher rates with retained gastric contents, including poor visualization (OR 68.9), aborted procedure (OR 25.5), and aspiration of gastric contents (OR 28.7). Conclusion: In our analysis a nearly 5-fold increase of retained gastric content on EGD exams with GLP-1RA use was seen (11.4% compared to 2.4%). Increased procedural limitations related to retained gastric contents as well as increased aspiration risk supports ongoing concern for higher peri-procedural risks with GLP-1RA use. The presence of associated confounders supports the recent recommendation by American College of Gastroenterology and American Gastroenterological Association advocating for an individualized approach to managing GLP-1RA ahead of endoscopy procedures.