P4099 - Risk of Gastric Food Retention With Glucagon-like Peptide 1 Receptor Agonists VS Diabetes Mellitus: A Case-Control Study From a Large Tertiary Care Health System

Firas Bahdi, MD¹, Vismaya S.. Bachu, MD², Vahagn Aldzhyan, MS³, Giuliana Perini Villanueva, MPH³, Songjingyi Liang, MS, MPH³, Arzoo Manandhar, BS³, Lynn S.. Connolly, MD³, Kevin A.. Ghassemi, MD³, Danny Issa, MD³, Venkataraman R. Muthusamy, MD^4
1David Geffen School of Medicine at UCLA, Glendora, CA; ²University of California Los Angeles Medical Center, Los Angeles, CA; ³David Geffen School of Medicine at UCLA, Los Angeles, CA; ⁴David Geffen School of Medicine at UCLA, Sherman Oaks, CA

Introduction: While glucagon-like peptide 1 receptor agonists (GLP1-RAs) increase the risk of gastric food retention, the confounding role of diabetes mellitus is still questioned. Additionally, there are discrepancies in guidance by anesthesia and gastroenterology societies to mitigate this risk without a strong evidence base. We here compare the risk of gastric food retention in patients on GLP1-RAs vs matched diabetics off GLP1-RAs while also assessing the role of 24-hour preprocedural liquid diet and bowel prep in mitigating this risk.

Methods: A retrospective case-control study of patients ≥18 years on GLP1-RAs vs matched diabetics off GLP1-RAs who underwent an outpatient EGD at a large tertiary care health system between Jan 2018 and June 2023, before anesthesia guidance on preprocedural dose holding was issued. The GLP1-RAs group included diabetic or pre-diabetic patients. Exclusion criteria included unconfirmed GLP1-RAs intake, gastroparesis, prior gastric surgery, and prescription of promotility agents or opioids. Primary outcomes were the risk of gastric food retention, EGD abortion, and periprocedural aspiration between groups. The secondary outcome was the gastric retention risk in GLP1-RAs patients who underwent EGD alone vs EGD + colonoscopy.

Results: Our study included 322 patients (174 cases + 148 controls) who underwent a total of 417 EGDs (212 cases + 205 controls). [Table 1] There was no significant difference in age, gender, BMI, insulin use, or preprocedural A1c% between groups. The controls were prescribed significantly more medications with a hypomotility effect (41.8% vs 21.8%, P< 0.01) and had higher glucose on procedure day (123 vs 107 mg/dl, P< 0.01). The gastric food retention was significantly higher in GLP1-RAs group compared to controls (4.7% vs 1%, P=0.03). There was no significant difference in EGD abortion (1.9% vs 0.5%, P=0.3) between groups. There was no periprocedural aspiration in either group. Compared to EGD alone (n=105), GLP1-RAs cases who underwent a concomitant colonoscopy (n=107) had a significantly lower risk of gastric food retention (9.5% vs 0%, P< 0.01).

Discussion: The GLP1-RAs independently increase the risk of gastric food retention compared to diabetes, but the absolute procedural risks remain minimal. A 24-hour liquid diet in association with bowel prep appear to offset the risk of gastric food retention with GLP1-RAs. Future studies should assess if 24-hour liquid diet alone can achieve similar effects and compare it to preprocedural dose holding.


Disclosures:


Firas Bahdi, MD¹, Vismaya S.. Bachu, MD², Vahagn Aldzhyan, MS³, Giuliana Perini Villanueva, MPH³, Songjingyi Liang, MS, MPH³, Arzoo Manandhar, BS³, Lynn S.. Connolly, MD³, Kevin A.. Ghassemi, MD³, Danny Issa, MD³, Venkataraman R. Muthusamy, MD⁴. P4099 - Risk of Gastric Food Retention With Glucagon-like Peptide 1 Receptor Agonists VS Diabetes Mellitus: A Case-Control Study From a Large Tertiary Care Health System, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.