Objective To assess whether use of glucagon-like peptide-1 (GLP-1) receptor agonists before upper gastrointestinal endoscopy is associated with increased risk of pulmonary aspiration or discontinuation of the procedure compared with sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Design Cohort study. Setting Two deidentified US commercial healthcare databases. Participants 43 365 adults (≥18 years) with type 2 diabetes who used a GLP-1 receptor agonist or SGLT-2 inhibitor within 30 days before upper gastrointestinal endoscopy. Main outcome measures The primary outcome was pulmonary aspiration on the day of or the day after endoscopy, defined using diagnostic codes. The secondary outcome was discontinuation of endoscopy. Risk ratios and corresponding 95% confidence intervals (CIs) were estimated after fine stratification weighting based on propensity score. Results After weighting, 24 817 adults used a GLP-1 receptor agonist (mean age 59.9 years; 63.6% female) and 18 537 used an SGLT-2 inhibitor (59.8 years; 63.7% female). Among users of GLP-1 receptor agonists and SGLT-2 inhibitors, the weighted risk per 1000 people was, respectively, 4.15 and 4.26 for pulmonary aspiration and 9.79 and 4.91 for discontinuation of endoscopy. Compared with SGLT-2 inhibitor use, GLP-1 receptor agonist use was not associated with an increased risk of pulmonary aspiration (pooled risk ratio 0.98, 95% CI 0.73 to 1.31), although it was associated with a higher risk for discontinuation of endoscopy (1.99, 1.56 to 2.53). Conclusions In this comparative cohort study, no increased risk of pulmonary aspiration during upper gastrointestinal endoscopy was observed among adults with type 2 diabetes using GLP-1 receptor agonists compared with SGLT-2 inhibitors within 30 days of the procedure; however, GLP-1 receptor agonists were associated with a higher risk of discontinuation of endoscopy, possibly owing to a higher risk of retained gastric content. In the absence of evidence from randomized trials, these findings could inform future practice recommendations on the preprocedural protocol for patients requiring endoscopy. A data use agreement is required for each of the data sources in this study. These data use agreements do not permit the authors to share patient level source data or data derivatives with individuals and institutions not covered under the data use agreements. The databases used in this study are accessible to other researchers by contacting the data providers and acquiring data use agreements or licenses.

中文翻译：

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上消化道内窥镜检查前胰高血糖素样肽-1 受体激动剂和肺误吸或手术中断的风险：队列研究


目的 评估与钠-葡萄糖协同转运蛋白-2 （SGLT-2） 抑制剂相比，在上消化道内镜检查前使用胰高血糖素样肽-1 （GLP-1） 受体激动剂是否与肺误吸或手术中断风险增加有关。设计 队列研究。设置 两个去标识化的美国商业医疗保健数据库。参与者 43 365 名成人 （≥18 岁） 患有 2 型糖尿病，他们在上消化道内窥镜检查前 30 天内使用过 GLP-1 受体激动剂或 SGLT-2 抑制剂。主要结局指标 主要结局是内窥镜检查当天或之后第二天的肺误吸，使用诊断代码定义。次要结局是停止内窥镜检查。在基于倾向评分的精细分层加权后估计风险比和相应的 95% 置信区间 （CIs）。结果 加权后，24 817 名成人使用 GLP-1 受体激动剂 （平均年龄 59.9 岁;63.6% 为女性），18 537 名使用 SGLT-2 抑制剂 （59.8 岁;63.7% 为女性）。在 GLP-1 受体激动剂和 SGLT-2 抑制剂的使用者中，每 1000 人的肺误吸加权风险分别为 4.15 和 4.26，停止内窥镜检查的加权风险为 9.79 和 4.91。与使用 SGLT-2 抑制剂相比，使用 GLP-1 受体激动剂与肺误吸风险增加无关 （汇总风险比 0.98,95% CI 0.73 至 1.31），尽管它与停止内窥镜检查的风险较高 （1.99， 1.56 至 2.53） 相关。 结论 在这项比较队列研究中，与使用 SGLT-2 抑制剂相比，在手术后 30 天内使用 GLP-1 受体激动剂的 2 型糖尿病成人患者在上消化道内窥镜检查期间未观察到肺误吸风险增加;然而，GLP-1 受体激动剂与内镜检查停止风险较高相关，这可能是由于胃内容物滞留的风险较高。在缺乏随机试验证据的情况下，这些发现可以为未来需要内窥镜检查的患者的术前方案的实践建议提供信息。本研究中的每个数据源都需要数据使用协议。这些数据使用协议不允许作者与数据使用协议未涵盖的个人和机构共享患者级别的源数据或数据衍生物。其他研究人员可以通过联系数据提供商并获取数据使用协议或许可证来访问本研究中使用的数据库。