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People on GLP-1 receptor agonists (RAs) had a significantly higher risk of aspiration pneumonia after undergoing gastrointestinal endoscopy, researchers reported.

Compared with 0.63% of non-users, 0.83% patients on a GLP-1 receptor agonist experienced aspiration pneumonia within a month of the procedure, Kevin Sheng-Kai Ma, DDS, of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues found.

This translated to a 33% higher risk after adjusting for 59 factors that could impact gut motility or aspiration risk (HR 1.33, 95% CI 1.02-1.74), they wrote in a pre-proof research letter.

"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 pointed out.

This class of diabetes and weight-management therapies -- which include semaglutide (Ozempic, Rybelsus, Wegovy), liraglutide (Victoza, Saxenda), dulaglutide (Trulicity), and tirzepatide (Mounjaro, Zepbound) -- has shot to popularity in recent years, but concerns have recently emerged about how the delayed gastric emptying mechanisms may translate to increased surgical risks under anesthesia.

In June 2023, the American Society of Anesthesiologists (ASA) released new guidance advising a 1-week hold of injectable GLP prior to elective surgery and a 1-day hold of once-daily agents. In a statement at the time, ASA President Michael Champeau, MD, said that while there is "currently a lack of scientific data on how GLP-1 receptor agonists affect patients having surgery and interact with anesthesia," the society created its new guidance based on anecdotal reports that the delay in stomach emptying may increase risk of regurgitation and aspiration of food into the airways and lungs during general anesthesia and deep sedation.

A few months later, the (AGA) released its own clinical practice update, not necessarily agreeing with ASA's blanket pre-surgical framework. After finding "no data" to support all patients stopping GLPs before endoscopic procedures, the AGA instead called an individualized approach for these patients.

Despite the current study findings, the AGA told 番茄社区 its recommendation statement "remains the same at this time."

For this population-based, retrospective analysis, Ma's group pulled de-identified health records from the TriNetX dataset. The final analysis included 778,253 non-GLP-users and 20,099 users. All patients underwent upper and/or lower endoscopies between 2018 and 2020. GLP users were considered those who were on an agent for more than 6 months and had two or more refills within 6 months before the procedure.

All were between the ages of 21 to 70 and 56.6% were female. Aspiration pneumonia risk did not differ by sex.

When broken down by endoscopy type, those who underwent a combined upper and lower endoscopy had the highest risk while those who only had a lower endoscopy didn't have an elevated risk:

• Combined upper and lower endoscopy: HR 2.26 (95% CI 1.23-4.16)
• Upper endoscopy: HR 1.82 (95% CI 1.27-2.60)
• Lower endoscopy: HR 0.56 (95% CI 0.25-1.27)

"This may result from stomach distension with carbon dioxide and the intermittent supine positioning during upper endoscopies, both factors potentially elevating aspiration risk," the researchers suggested. "This distinction advocates a more tailored guideline in managing GLP-1 RA use based on the type of procedure."

An elevated risk of aspiration pneumonia was also seen in patients with propofol-assisted endoscopies (HR 1.49, 95% CI 1.08-2.06) and not in patients where propofol wasn't used (HR 1.31, 95% CI 0.78-2.20). This was "likely due to impaired airway protection reflexes," the researchers pointed out.

Because of the retrospective nature of the study, data on medication adherence and cessation of medications prior to surgery were not available. Also, because case data were pulled from 2018 to 2020 -- prior to many GLP's gaining weight-management indications -- only a small subgroup of GLP users without diabetes were included.

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