S1242 Glucagon-Like Peptide-1 Receptor Agonists and Upper Endoscopy: A Data-Driven Approach to Pre-Procedural Optimization

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used in the treatment of type 2 diabetes mellitus and obesity. However, their effect on delaying gastric emptying can complicate upper endoscopy (EGD), where gastric clearance is critical for procedural safety and visualization. Despite these concerns, formal guidance on peri-procedural GLP-1 RA management has been inconsistent. In response, our institution implemented a standardized protocol requiring a 24-hour clear liquid diet and temporary discontinuation of GLP-1 RAs prior to EGD. This study assessed the protocol’s impact on gastric food retention, procedure cancellations, and repeat EGDs within 30 days. Methods: We conducted a retrospective cohort study across the Geisinger health system comparing outcomes before (January 2022–August 2023) and after (September 2023–December 2024) implementation of a standardized protocol requiring a 24-hour clear liquid diet and temporary discontinuation of GLP-1 RA medications prior to EGD. Daily-dosed medications were held the morning of the procedure, whereas weekly formulations were held for 3 days prior. Adults (≥18 years) with GLP-1 RA use within 90 days of outpatient EGD were included; those with gastroparesis were excluded. The primary outcome was gastric food retention per EGD reports. Secondary outcomes included aborted procedures and repeat EGDs within 30 days. Logistic regression was adjusted for age, sex, body mass index, and race/ethnicity. Analyses were stratified by diabetes status. Results: Among 641 pre-intervention and 554 post-intervention EGDs, the mean patient age was 52 years; 69% were women, and 59% had diabetes. Food retention significantly decreased post-intervention (11.4% vs 5.1%; 95% CI: 0.27–0.65; P = 0.0001) regardless of diabetes status. Among those with food retention, a higher proportion had only small-volume retention post-intervention (30% vs 4%; P = 0.0043). Repeat EGDs within 30 days declined significantly (2.5% vs 0.4%; P = 0.0030) and aborted procedures trended lower (1.4% vs 0.4%; P = 0.072). Conclusion: Implementation of a GLP-1 RA pre-endoscopy guideline significantly reduced food retention, lowering aspiration risk, procedure cancellations, and unnecessary repeat EGDs. These findings highlight a scalable, cost-effective intervention that improves endoscopic efficiency and may reduce healthcare costs by minimizing anesthesia use, provider time, and operating room resources.