S1241 Impact of GLP-1 Receptor Agonist Guidelines Change on Post-Endoscopic Complications: A Propensity-Matched Multi-Center Study

Introduction: American Society of Anesthesiologists (ASA) guidelines recommend withholding glucagon-like peptide-1 receptor agonists (GLP-1 RAs) prior to gastrointestinal endoscopy due to concerns of delayed gastric emptying and aspiration risk. However, supporting evidence remains limited. This study compares short-term complications among GLP-1 RA users before and after the adoption of these guidelines. Methods: The TriNetX US Collaborative Network was queried for adults aged 21–70 years with type 2 diabetes, body-mass index ≥30 kg/m², and ≥1 prescription for dulaglutide, liraglutide, or semaglutide ≥6 months before an endoscopic procedure. Bariatric-surgery patients were excluded. Cohort A (post-ASA guideline) comprised procedures from June 28, 2023, to March 31, 2025; Cohort B (pre- ASA guideline) from September 1, 2021, to June 27, 2023. 1:1 nearest-neighbor propensity-score matching balanced 27595 patients per cohort. Primary outcome was aspiration pneumonia; secondary outcomes were acute myocardial infarction (MI), cerebral infarction, intensive care unit (ICU) admission, acute respiratory failure, acute kidney injury (AKI), CPAP ventilation, and all-cause mortality, captured within 7 days of the index procedure. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Event rates were low and did not differ significantly between periods. Aspiration pneumonia rates were nearly identical (0.11%; 29 events post-guideline vs 30 pre-guideline; OR 0.97, 95% CI 0.58–1.61; P = 0.90). Similarly, no differences were observed for acute myocardial infarction (0.28% vs 0.32%; OR 0.85, 95% CI 0.63–1.16; P = 0.31), cerebral infarction (0.41% vs 0.39%; OR 1.05, 95% CI 0.80–1.36; P = 0.74), ICU admission (0.42% vs 0.39%; OR 1.09, 95% CI 0.84–1.42; P = 0.50), acute respiratory failure (0.26% vs 0.30%; OR 0.88, 95% CI 0.64–1.20; P = 0.42), acute kidney injury (0.67% vs 0.66%; OR 1.02, 95% CI 0.83–1.25; P = 0.88), CPAP ventilation (0.27% vs 0.23%; OR 1.16, 95% CI 0.83–1.62; P = 0.39), or all-cause mortality (0.04% vs 0.05%; OR 0.92, 95% CI 0.42–2.02; P = 0.84). Kaplan-Meier survival analyses also revealed no significant differences. Conclusion: In this large matched GLP-1 RA users, implementation of withholding guidance did not reduce aspiration or any other acute complication after endoscopy. Given the very low event rates and null associations, routine discontinuation of GLP-1 RAs before endoscopy may be unnecessary in many patients; prospective studies are warranted to refine peri-procedural recommendations.