P2375 - Are ASA Guidelines Regarding the Holding Of GLP-1 Agonists Before Endoscopy Enough to Reduce Aspiration Risk?

Brennan Gioe, MD¹, Scott Gioe, MD^2
1Baylor College of Medicine, Houston, TX; ²Gastroenterology Center PA, Gulfport, MS

Introduction: Due to concerns that delayed gastric emptying caused by GLP-1 agonists can increase the risk of pulmonary aspiration during procedures, the American Society of Anesthesiologists (ASA) released guidelines in July of 2023 to hold daily GLP-1 agonists the day of the procedure and weekly GLP-1 agonists a week prior to the procedure.

Methods: We performed a retrospective analysis of all the patients (n=857) at our endoscopy center who underwent a morning EGD performed by a single endoscopist in the year of 2023. We used endoscopically visualized retained gastric food (RGF) as a surrogate for aspiration risk. ASA guidelines were implemented during the month of August, so we separated our patients into two groups based on if they had their procedure from Jan 1-July 31 or Sept 1-Dec 31. Patients from August were excluded due to inconsistent implementation of ASA guidelines. We only included patients in this study that were taking GLP-1 agonists for diabetes (DM) at the time of their pre-procedural office visit, because previous data suggests these patients to be at the greatest risk for aspiration during endoscopy. We also separated our patients into those who underwent a standard overnight fast (n=21) and those who underwent overnight fast plus a 24-hour liquid diet (these patients were also receiving a colonoscopy) (n=46) to see if fasting length influenced aspiration risk.

Results: Before ASA guidelines were implemented, 50% of patients on a standard length fast while taking GLP-1 agonists for DM were found to have RGF during endoscopy. The percentage of patients with RGF was also 50% when reviewing those on GLP-1 agonists for DM with a standard fast after the ASA guidelines were implemented. When reviewing patients on GLP-1 agonists for DM that had an extended fast pre-ASA guideline implementation, 21.9% had RGF. After ASA guidelines were introduced, zero patients with a prescribed GLP-1 agonist on an extended fast had RGF on endoscopy.

Discussion: Based on our study, ASA guidelines regarding holding GLP-1 agonists before a procedure do not appear to influence aspiration risk during endoscopy for patients with a standard overnight fast. However, a prolonged fast combined with using the ASA guidelines for holding GLP-1 agonists prior to endoscopy virtually eliminates risk of pulmonary aspiration. In patients on GLP-1 agonists with a concurrent diagnosis of DM, we recommend a prolonged fasting period as well as holding the patient’s GLP-1 agonist for 1 dosing interval prior to endoscopy.


Disclosures:


Brennan Gioe, MD¹, Scott Gioe, MD². P2375 - Are ASA Guidelines Regarding the Holding Of GLP-1 Agonists Before Endoscopy Enough to Reduce Aspiration Risk?, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.