S1289 Peri-Operative Use of Glucagon-Like Peptide 1 (GLP-1) Agonists Is Associated with Retained Gastric Contents During Upper Endoscopy and Procedure Abortion, But Not With Procedural Complications

Introduction: Initial consensus-based guidance by the American Society of Anesthesiologists (AGA) recommended peri-operative interruption of glucagon-like peptide 1 (GLP-1) agonists in all patients receiving general anesthesia or deep sedation, including those undergoing upper endoscopy, given concerns for delayed gastric emptying and procedural complications. However, subsequent peer-reviewed literature prompted updated multi-society guidance, which suggests an individualized approach and shared-decision making. This study will add to the growing body of evidence regarding the procedural impact of peri-operative GLP-1 agonist use. Methods: A large retrospective cohort study at a tertiary care safety-net hospital was performed on all adult patients undergoing elective outpatient upper endoscopy between November 2022 and October 2023. Patients with previous upper gastrointestinal surgeries and those with a history of prolonged mechanical ventilation were excluded. Patient demographics, clinical data and procedural outcomes were collected and a Fischer’s exact 2-sided test was performed. Results: 3,150 charts were reviewed and 2,215 patients were included in the study, 107 of whom had an active prescription for an oral or intramuscular GLP-1 agonist. GLP-1 agonist use was significantly associated with higher rates of both retained gastric contents (RR 3.93, CI 1.82–7.67; P = 0.004) and procedure abortion (RR 4.886, CI 1.71–10.98; P = 0.022). There were no cases of peri-operative aspiration or ensuing complications identified in any of the patients using GLP-1 agonists. Conclusion: While peri-operative GLP-1 use was associated with a nearly 4-times greater risk of retained gastric contents and a nearly 5-times greater rate of subsequent procedure abortion, this did not portend any increased risk of procedural complications, notably aspiration events. Furthermore, the overall number of cases with documented retained gastric contents was small. This data supports the more recent multi-society clinical guidance suggesting a more individualized patient approach toward GLP-1 agonist interruption prior to endoscopic procedures. Further studies will seek to standardize which patient and medication factors warrant peri-operative interruption of GLP-1 agonists to minimize procedural risk and help avoid unnecessary procedural cancellation or abortion.