GLP-1 agonists linked to food retention in EGD, but not combined EGD-colonoscopy

Editor's Note

Patients using GLP-1 receptor agonists (GLP-1 RAs) have a higher risk of food retention during esophagogastroduodenoscopy (EGD) when performed alone, but not when combined with a colonoscopy, according to a retrospective study from Cedars-Sinai Medical Center. MedPage Today reported the news October 1.

The study included 70 patients using GLP-1 RAs matched with 139 controls based on age, body mass index (BMI), sex, and procedure type. All participants were actively using GLP-1 medications within seven days of their procedures, and none were taking prokinetics or had altered gastrointestinal anatomy. Among the 209 patients, those undergoing both EGD and colonoscopy had no instances of food retention, regardless of whether they were taking GLP-1 drugs, MedPage reports. However, 17.4% of patients on GLP-1 drugs who underwent EGD alone experienced food retention, compared to none of the non-users in the same group.

GLP-1 RAs, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), are known to cause delayed gastric emptying, raising concerns about food retention, which can increase the risk of aspiration during procedures, the article notes. The study highlights that colonoscopy preparation protocols, which require a 24-hour clear liquid diet, may offer protection against food retention in combined procedures. According to researchers, the colonoscopy preparation process seems to mitigate the risks of retained gastric contents during upper endoscopy.

No instances of periprocedural aspiration occurred in either group, but patients on GLP-1 RAs undergoing colonoscopy were more likely to experience inadequate bowel preparation (21.3% vs. 6.5% in non-users), MedPage reports. This issue was particularly notable in patients undergoing a combined EGD-colonoscopy, where inadequate bowel preparation was reported in 33.3% of GLP-1 users compared to 6.3% of non-users. Poor bowel preparation can lead to complications, including missed lesions and canceled procedures, which contribute to wasted healthcare resources and patient dissatisfaction.

The findings suggest that adhering to colonoscopy preparation guidance may reduce the risk of food retention and procedural complications in patients taking GLP-1 drugs. However, researchers say further studies are needed to confirm the protective effect of colonoscopy prep and validate these findings in the context of preoperative risk assessment.

GLP-1 drugs have come under scrutiny due to their potential for delayed gastric emptying, which could increase the risk of aspiration during surgeries. The American Society of Anesthesiologists (ASA) issued guidance last year advising patients to halt GLP-1 use ahead of elective procedures, recommending cessation seven days prior for weekly injectable forms and on the day of surgery for once-daily medications. However, this study's findings highlight the importance of individualized recommendations based on patient-specific risk factors.