INTRODUCTION While ubiquity of glucagon-like peptide receptor agonists (GLP1-RAs) is rising, guidance from the gastroenterology societies and American Society of Anesthesiologist (ASA) remains in conflict on recommendations regarding preoperative holding before endoscopy. The aim of this study was to address this by evaluating the effect of GLP1-RAs on gastric retention during upper endoscopy. METHODS This multicenter cross-sectional study included patients on confirmed GLP1-RAs receiving an endoscopy from 2021 to 2023. Demographics, prescribing practices, and procedure outcomes were captured. GLP1-RA management of preoperative holding was retroactively classified per ASA guidance. Multivariable logistic regression was performed to assess factors influencing retained gastric contents. RESULTS Of 815 patients, 70 (8.7%) had retained gastric contents on endoscopy of whom 65 (93%) had type 2 diabetes mellitus. Only 1 (1.4%) of these patients required unplanned intubation, and none had aspiration events. Those with GLP1-RA held per ASA guidance (406, 49.8%) were less likely to have retained contents (4.4% vs 12.7%, P < 0.001), but there were no significant differences to intubation (0% vs 2%, P = 0.53) or aborting procedure rates (28% vs 18%, P = 0.40) due to gastric retention. On multivariable analysis, likelihood of food retention increased 36% (95% confidence interval 1.15-1.60) for every 1% increase in hemoglobin A1C after adjusting for GLP1-RA type and preoperative medication hold. DISCUSSION In this multicenter study, very low rates of retained gastric contents were seen during endoscopy in patients on GLP1-RAs and most were in patients with type 2 diabetes mellitus. Our findings suggest an individualized approach rather than universal preoperative holding of medications before endoscopy.

中文翻译：

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内窥镜检查前使用胰高血糖素样肽受体激动剂与低残留胃内容物相关：多中心横截面分析。


引言 虽然胰高血糖素样肽受体激动剂 (GLP1-RA) 的普及率正在上升，但胃肠病学协会和美国麻醉医师协会 (ASA) 的指导对于内窥镜检查前术前保持的建议仍然存在冲突。本研究的目的是通过评估 GLP1-RAs 对上消化道内窥镜检查期间胃潴留的影响来解决这个问题。方法 这项多中心横断面研究纳入了 2021 年至 2023 年接受内窥镜检查的确诊 GLP1-RA 患者。记录了人口统计数据、处方实践和手术结果。根据 ASA 指南对术前持有的 GLP1-RA 管理进行追溯分类。进行多变量逻辑回归来评估影响残留胃内容物的因素。结果 815 例患者中，70 例（8.7%）经内镜检查发现胃内容物残留，其中 65 例（93%）患有 2 型糖尿病。这些患者中只有 1 名 (1.4%) 需要计划外插管，并且没有人发生误吸事件。根据 ASA 指南持有 GLP1-RA 的患者 (406, 49.8%) 保留内容物的可能性较小 (4.4% vs 12.7%, P < 0.001)，但与插管没有显着差异 (0% vs 2%, P = 0.53）或由于胃潴留导致的中止手术率（28% vs 18%，P = 0.40）。在多变量分析中，调整 GLP1-RA 类型和术前药物保留后，糖化血红蛋白每增加 1%，食物滞留的可能性就会增加 36%（95% 置信区间 1.15-1.60）。讨论 在这项多中心研究中，使用 GLP1-RA 的患者进行内窥镜检查时发现胃内容物滞留率非常低，其中大多数是 2 型糖尿病患者。 我们的研究结果表明，在内窥镜检查前应采取个体化的方法，而不是普遍的术前保留药物。