Study: GLP weight loss, diabetes therapies boost GI endoscopy pneumonia risk

Editor's Note

Gastrointestinal endoscopy could increase the risk of aspirational pneumonia in patients using GLP-1 receptor agonists (RAs) to manage weight or treat diabetes, according to an April 1 report from MedPage today.

Citing research published in the journal Gastroenterology by a team led by Kevin Sheng-Kai Ma, DDS, of Brigham and Women's Hospital and Harvard Medical School in Boston, the report notes that 0.83% patients on a GLP-1 receptor agonist experienced aspiration pneumonia within a month of the procedure, compared with 0.63% of non-users.

This translated to a 33% higher risk after adjusting for 59 factors that could impact gut motility or aspiration risk. "Holding GLP-1 RAs before endoscopy may disrupt diabetes management and increase procedure cancellations, yet our findings suggest this practice is justified by the increased, albeit modest, risk of aspiration, especially in upper GI and propofol-assisted procedures," the researchers wrote.

According to the report, the population-based, retrospective analysis of de-identified health records from the TriNetX dataset included 778,253 non-GLP-users and 20,099 users, defined as those using regularly for at least 6 months prior to endoscopies conducted between 2018 and 2020. The risk of aspiration pneumonia was greatest with combined upper and lower endoscopy procedures. Lower endoscopy alone did not increase risk. The study also found higher risk in patients with propofol-assisted endoscopies than those who were not administered propofol, which researchers attribute to “impaired airway protection reflexes.”

The MedPage Today report provides more details on the context of the research, including conflicting recommendations from the American Society of Anesthesiologists and the American Gastroenterology Association, as well as limitations, including study size and lack of data on preoperative medication adherence and cessation.