Food Retention Risk Low for GLP-1 Users When Endoscopy Is Combined With Colonoscopy

Patients on GLP-1 receptor agonists had a low risk of food retention when an esophagogastroduodenoscopy (EGD) was combined with a colonoscopy, a small retrospective study found.

Among more than 200 adults in the analysis, there were no instances of gastric food retention for the patients who underwent a combined EGD-colonoscopy, regardless of GLP-1 drug use, reported Ruchi Mathur, MD, of Cedars-Sinai Medical Center in West Hollywood, California, and colleagues.

But among the group undergoing an EGD alone, food retention occurred in 17.4% of patients on a GLP-1 drug versus none of the non-users (P=0.006). Of the four cases of retention, one was graded as moderate and three were graded as large, the study authors detailed in a JAMA Network Open research letter.

“There is a clear association between the use of GLPs and increased risks of food retention during upper endoscopy,” Mathur told MedPage Today. But colonoscopy preparation protocols — which involve a 24-hour clear liquid diet to empty the colon — “appear to confer a protective effect and decrease the risks of food retention,” she added.

No cases of periprocedural aspiration occurred among any of the patients, but GLP-1 agonist users undergoing colonoscopy were more likely to have inadequate bowel preparation versus non-users (21.3% vs 6.5%, P=0.009), a difference driven by the group undergoing combined EGD-colonoscopy (33.3% vs 6.3%, P=0.003).

Unsatisfactory bowel preparation can carry significant risks for missed lesions, patient dissatisfaction, and cancellation of procedures, leading to wasted resources, said Mathur.

While the “findings suggest that patients who adhere to colonoscopy preparation guidance may be at a low risk of retained gastric contents and aspiration,” according to the researchers, “future studies are necessary to confirm and validate the role of this finding in preoperative risk assessment.”

GLP-1 drugs such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) — used to treat type 2 diabetes and for chronic weight management — are associated with delayed gastric emptying and constipation.

Due to the potential risk for aspiration during surgery from food retention, the American Society of Anesthesiologists (ASA) last year advised patients taking GLP-1 agonists to halt use ahead of elective procedures. It’s recommended that patients stop 7 days prior if they’re on a weekly injectable or the day of surgery if on once-daily drugs, but research has questioned whether that timeframe should be extended.

Mathur said the new study findings “support the value of individualizing recommendations for patients and having risk-benefit discussions for patients taking these medications.” This may be important in preprocedural and same-day procedure counseling to avoid cancellation if patients did not pause their GLP-1 agonist beforehand.

Their single-center cross-sectional study included 209 patients undergoing an EGD alone (33%), a colonoscopy alone (33%), or a combined procedure (34%) from January to June 2023 — prior to ASA’s guidance. A total of 70 patients on a GLP-1 receptor agonist were matched to 139 controls based on age, body mass index (BMI), sex, and procedure type. Participants had to be actively taking the GLP-1 drug within 7 days of their procedure. They also could not be using prokinetics or have surgically modified gastrointestinal anatomy.

Average patient age was 62.7 years, their BMI was a mean 34.4. Among the GLP-1 receptor agonist users, 46% were on semaglutide, 30% were on dulaglutide (Trulicity), 20% were on tirzepatide, and 4% were on liraglutide (Victoza, Saxenda).

Inadequate bowel preparation in the study was defined as having to stop the procedure due to stool burden or a Boston Bowel Preparation Scale score of less than 6 (total possible score 9) or 0 (total possible score 3) in any single bowel segment.

Because of the small sample size, the researchers weren’t able to include any instances of rarer procedural events like aspiration. Other study limitations were an inability to match participants for more clinical factors, like diabetes, or stratify based on specific GLP-1 receptor agonist or dose strength.

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