P0667 - Safety of MAC Anesthesia in Patients Taking GLP-1RA Undergoing EGD vs Colonoscopy vs Bidirectional Endoscopy: A Retrospective Analysis

Rabih Ghazi, MD¹, Kimberly Tena Diaz, DO², Rasha Abi Radi Abou Jaoudeh, MD³, Karl Akiki, MD¹, Jaclyn Levendusky, BS⁴, Krysta Contino, MD⁵, Rachel Frank, MD⁶, Apeksha Shah, MD⁷, Christina Tofani, MD, FACG⁸, Adib Chaaya, MD^9
1Cooper University Hospital, Philadelphia, PA; ²Cooper University Health Care, Camden, NJ; ³Cleveland Clinic Foundation, Cleveland, OH; ⁴Cooper Medical School of Rowan University, Camden, NJ; ⁵Digestive Health Institute at Cooper University Hospital, Mount Laurel, NJ; ⁶Cooper University Hospital, Mt. Laurel, NJ; ⁷Digestive Health Institute at Cooper University Hospital, Mt. Laurel, NJ; ⁸Digestive Health Institute at Cooper University Hospital, Camden, NJ; ⁹Cooper 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 the risk of aspiration from retained stomach contents, particularly with monitored anesthesia care (MAC). There is growing interest in determining if special considerations are needed for subgroups of GLP-1RA patients undergoing endoscopy, but data remain limited. This study compares the safety of esophagogastroduodenoscopy (EGD) vs. colonoscopy vs. bidirectional endoscopy (EGD + colonoscopy) 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 EGD ± 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 from the study. Patients were divided into three groups based on the procedure they received: 1) EGD, 2) Colonoscopy, and 3) Bidirectional (EGD + colonoscopy). 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 135 patients were included (28 in Group 1, 64 in Group 2, 43 in Group 3). The procedure time was longer in the Colonoscopy and Bidirectional groups compared to the EGD group (p-value < 0.001 for both), and for the Bidirectional group compared to the Colonoscopy group (p = 0.031). The Colonoscopy group had a higher proportion of Mallampati Class III and a lower proportion of GERD and antisecretory medication use compared to the both other groups, and a lower proportion of gastroparesis and ASA Class III than the EGD group. The EGD, Colonoscopy, and Bidirectional groups had similar rates of overall AEs (14.3% vs 7.8% vs 18.6%; p = 0.138) and intra-procedure hypotension (10.7% vs 3.1% vs 14.0%; p = 0.114) and hypoxemia (3.6% vs 3.1% vs 7.0%; p = 0.618). No post-procedure AEs were observed.

Discussion: MAC anesthesia appears to be safe for patients taking GLP-1RA undergoing either EGD, colonoscopy, or bidirectional endoscopy, with comparable rates of intra-procedure AEs despite the added procedure time of the colonoscopy component. Additionally, the observed intra-procedure AEs did not confer any increased risk of post-procedure complications.


Disclosures:


Rabih Ghazi, MD¹, Kimberly Tena Diaz, DO², Rasha Abi Radi Abou Jaoudeh, MD³, Karl Akiki, MD¹, Jaclyn Levendusky, BS⁴, Krysta Contino, MD⁵, Rachel Frank, MD⁶, Apeksha Shah, MD⁷, Christina Tofani, MD, FACG⁸, Adib Chaaya, MD⁹. P0667 - Safety of MAC Anesthesia in Patients Taking GLP-1RA Undergoing EGD vs Colonoscopy vs Bidirectional Endoscopy: A Retrospective Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.