P0666 - Does ASA Physical Status Class Affect Outcomes of Endoscopy Under MAC Anesthesia in Patients on GLP-1: A Retrospective Cohort Analysis

Rabih Ghazi, MD¹, Jaclyn Levendusky, BS², Karl Akiki, MD¹, Rasha Abi Radi Abou Jaoudeh, MD³, Kimberly Tena Diaz, DO⁴, Fariha Hasan, MD⁵, Rachel Frank, MD⁶, Christina Tofani, MD, FACG⁷, Krysta Contino, MD⁸, Apeksha Shah, MD⁹, Adib Chaaya, MD^10
1Cooper University Hospital, Philadelphia, PA; ²Cooper Medical School of Rowan University, Camden, NJ; ³Cleveland Clinic Foundation, Cleveland, OH; ⁴Cooper University Health Care, Camden, NJ; ⁵Cooper University Hospital, Camden, NJ; ⁶Cooper University Hospital, Mt. Laurel, NJ; ⁷Digestive Health Institute at Cooper University Hospital, Camden, NJ; ⁸Digestive Health Institute at Cooper University Hospital, Mount Laurel, NJ; ⁹Digestive Health Institute at Cooper University Hospital, Mt. Laurel, NJ; ¹⁰Cooper Health Gastroenterology, Camden, NJ

Introduction: Recent concerns have been raised about the safety of glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients undergoing endoscopy due to a potential risk of aspiration from retained stomach contents, particularly with the widespread use of monitored anesthesia care (MAC). There is growing interest in determining whether special considerations should be taken for subgroups of GLP-1RA patients undergoing endoscopy. However, data on this topic remain limited. In this study, we evaluate the effect of the American Society of Anesthesiologists (ASA) physical status classification on the safety of endoscopy under MAC anesthesia in patients taking GLP-1RA.

Methods: This retrospective chart review included patients on GLP-1RA for diabetes or weight management who underwent esophagogastroduodenoscopy (EGD) with or without colonoscopy between October 1, 2018, and October 1, 2023. Patients who discontinued GLP-1RA at least one week before the procedure and those with altered gastrointestinal anatomy were excluded. Patients were divided into ASA Class II and Class III groups. ASA Classes I and IV were excluded due to low numbers to ensure group homogeneity. The primary outcome was overall adverse events (AEs) rates. Outcomes were compared using Pearson's chi-square or Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon rank-sum test for continuous variables.

Results: A total of 127 patients were included (65 ASA II and 62 ASA III). The ASA III group had higher BMI (36.3 vs 30.4 kg/m2; p< 0.001), Mallampati scores (24.2% vs 4.6% Mallampati III; p=0.004), proportion of lung disease (53.2% vs 29.2%; p=0.006) and heart failure (22.6% vs 3.1%; p=0.001) compared to the ASA II group. Baseline characteristics were otherwise comparable between both groups (Table 1). Both ASA II and ASA III groups had similar rates of overall AEs (9.2% vs 14.5%; p=0.356) and intra-procedure AEs (9.2% vs 14.5%; p=0.356), hypotension (7.7% vs 8.1%; p=0.938) and hypoxemia (3.1% vs 6.5%; p=0.370). No post-procedure AEs were observed in either group.

Discussion: The rates of intra-procedure AEs did not differ between the ASA II and ASA III groups and did not confer any increased risk for post-procedure complications. Therefore, endoscopy under MAC anesthesia appears to be safe for ASA Class II and III patients taking GLP-1RA. Additional studies are needed to assess the outcomes in ASA Class IV patients.


Disclosures:


Rabih Ghazi, MD¹, Jaclyn Levendusky, BS², Karl Akiki, MD¹, Rasha Abi Radi Abou Jaoudeh, MD³, Kimberly Tena Diaz, DO⁴, Fariha Hasan, MD⁵, Rachel Frank, MD⁶, Christina Tofani, MD, FACG⁷, Krysta Contino, MD⁸, Apeksha Shah, MD⁹, Adib Chaaya, MD¹⁰. P0666 - Does ASA Physical Status Class Affect Outcomes of Endoscopy Under MAC Anesthesia in Patients on GLP-1: A Retrospective Cohort Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.