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S848 Perioperative GLP-1 Receptor Agonist Impact on Endoscopy and Colonoscopy Outcomes: A Systematic Review and Meta-Analysis
Abstract   Peer reviewed

S848 Perioperative GLP-1 Receptor Agonist Impact on Endoscopy and Colonoscopy Outcomes: A Systematic Review and Meta-Analysis

Yahya Alsawaf, Samer Saadi, Zein Tarakji, Moustafa Hegazi, Muhamad Oum, Siddharth Singh and M. Hassan Murad
The American journal of gastroenterology, Vol.119(10S), pp.S584-S585
10/2024
DOI: 10.14309/01.ajg.0001032760.30423.11

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Abstract

Introduction: Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are effective in managing type 2 diabetes mellitus and promoting weight loss, but their perioperative safety remains a concern. This systematic review evaluates the effects of GLP1-RAs on perioperative complications of endoscopy (EGD) and colonoscopy procedures. Methods: We comprehensively searched several databases, from each database's inception to April 2024, in the English language. The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Controlled vocabulary supplemented with keywords was used to search for perioperative complications in patients taking GLP-1 agonists. This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements. We included RCTs and observational studies. Results: Our electronic search identified 2291 citations, from which 7 studies reported perioperative complications in EGD and colonoscopy were included. EGD: Five observational studies revealed an increased risk of retained gastric content (RGC) in EGD with GLP-1 RAs use (OR: 4.738; 95% CI, 3.177-7.065; P< 0.001) (Figure 1A). While 2 studies reported a higher risk of intubation during EGD with GLP1-RA use (OR: 4.454; 95% CI, 1.371-14.471; P=0.013) (Figure 1B), they found no significant increase in pulmonary aspiration risk (OR: 2.093; 95% CI, 0.174-25.141; P=0.560) (Figure 1C). One study showed no increased risk of needing to repeat EGD with GLP1-RAs use (OR: 1.992; 95% CI, 0.039-101.617). Colonoscopy: Two studies indicated an increased risk of inadequate bowel cleaning with GLP-1 RAs use (OR: 1.579; 95% CI, 1.104-2.394; P=0.032) (Figure 1D). Notably, only one study reported an increase in the need for repeat colonoscopy (OR: 1.816; 95% CI, 1.05-3.141). One study found no association between GLP-1 RAs (liraglutide) use and hypoglycemia during colonoscopy (OR: 0.881; 95% CI, 0.328-2.366). Conclusion: GLP1-RAs use was associated with an increased risk of RGC and inadequate bowel preparation, which impacted the quality of EGD and colonoscopy. Although some clinicians recommend withholding GLP1-RAs preoperatively, evidence is insufficient. Further robust research is needed to assess perioperative risks and determine whether modifying medication or fasting protocols can mitigate these adverse events (Table 1).

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