S2264 Evaluating the Safety of GLP-1 Receptor Agonists in ERCP: A Propensity-Matched Analysis of Aspiration and Procedural Outcomes Before and After ASA Guideline Changes

Introduction: GLP-1 receptor agonists (GLP-1 RAs) have become a cornerstone in managing type 2 diabetes and obesity but raise concerns regarding delayed gastric emptying and potential peri-procedural complications. Their safety in endoscopic retrograde cholangiopancreatography (ERCP), particularly regarding aspiration risk remains unclear, especially in light of updated ASA guidelines recommending pre-procedural withholding. Methods: We used TriNetX, a federated network of de-identified electronic health records from U.S. healthcare systems, we identified adults who underwent ERCP with or without prior GLP-1 RA exposure (≥6 months of semaglutide, liraglutide, dulaglutide, or tirzepatide). Patients were matched 1:1 using propensity scores across 25 variables, including comorbidities and laboratory values. The primary outcome was aspiration pneumonitis within 7 days post-ERCP. Secondary outcomes included post-ERCP pancreatitis (PEP), ICU admission, emergency intubation, GI bleeding, perforation, and all-cause mortality. A sensitivity analysis compared GLP-1 RA users undergoing ERCP before vs after the 2023 ASA guidelines. Results: After propensity matching (n = 3,218 per cohort), aspiration pneumonitis occurred in 0.3% of GLP-1 users compared to 0.5% of non-users (OR: 0.59; 95% CI: 0.27–1.28; P = 0.177). GLP-1 use was associated with a significantly lower rate of ICU admission (3.6% vs 4.8%; OR: 0.74; 95% CI: 0.58–0.95; P = 0.018). Rates of post-ERCP pancreatitis (10.7% vs 10.4%; P = 0.746), GI bleeding, perforation, emergency intubation, and all-cause mortality were comparable between groups. In a sensitivity analysis, outcomes remained consistent when comparing GLP-1 users undergoing ERCP before versus after the 2023 ASA guideline update. Conclusion: GLP-1 RA use prior to ERCP was not associated with increased aspiration risk or adverse procedural outcomes. The consistency of outcomes before and after the ASA guideline update supports the peri-procedural safety of GLP-1 RAs and raises questions about the routine need to withhold therapy before endoscopic procedures.