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GLP-1 Agonists and the Risk of Pulmonary Aspiration during Elective Upper Endoscopy: A Systematic Review and Meta-analysis
iD
Authors Info & Affiliations
Abstract
Introduction
Glucagon-like Peptide-1 (GLP-1) agonists cause delayed gastric emptying by acting on vagal afferent nerves. Retained Gastric Contents (RGC) increase the risk of pulmonary aspiration, particularly under anesthesia in endoscopic procedures. This systematic review and meta-analysis summarize the current evidence on pulmonary aspiration in patients receiving GLP-1 agonists who undergo endoscopy.
Methods
A systematic review of the literature was conducted using Cochrane, Embase, and PubMed from inception to May 2024, including studies and case reports on GLP-1 agonists and pulmonary aspiration. Data on study characteristics, demographics, and GLP-1 agonist use were collected. A pooled analysis of retrospective studies was conducted using RevMan version 5.4.1. The study protocol was registered in the PROSPERO international database (ID CRD42024595241).
Results
We identified five case reports involving six patients and twelve studies, including 210,216 patients. A total of 143/87691 (0.16%) in the GLP-1 agonist and 149/122525 (0.12%) in the placebo group had pulmonary aspiration. In the case reports, three patients had aspiration despite stopping medication >6 days prior to the procedure and fasting for >8 hours. Meta-analysis showed that GLP-1 agonists were associated with an odds ratio of 1.23 for pulmonary aspiration (P = 0.59; 95% CI, 0.58 to 2.60), which was not statistically significant.
Conclusion
Our analysis found no statistically significant association between GLP-1 agonist use and the risk of pulmonary aspiration during endoscopic procedures. Further research is needed to determine optimal fasting protocols and peri-procedural management strategies.
