Patients using GLP-1 receptor agonists before upper gastrointestinal endoscopy have nearly double the risk of procedure discontinuation compared to those on SGLT-2 inhibitors, as shown in a recent cohort study.

The study examined pulmonary aspiration risk and endoscopy discontinuation in patients using glucagon-like peptide-1 (GLP-1) receptor agonists. Researchers analyzed data from 43,365 adults with type 2 diabetes who used either a GLP-1 receptor agonist or a sodium-glucose cotransporter-2 (SGLT-2) inhibitor within 30 days before endoscopy. The objective was to determine if GLP-1 receptor agonists, which delay gastric emptying, increase pulmonary aspiration risk compared to SGLT-2 inhibitors.

The primary outcome, pulmonary aspiration, showed no significant difference between the GLP-1 and SGLT-2 groups (4.15 vs. 4.26 per 1,000; risk ratio 0.98, 95% CI 0.73-1.31). However, the secondary outcome of endoscopy discontinuation was higher in GLP-1 users than SGLT-2 users (9.79 vs. 4.91 per 1,000; risk ratio 1.99, 95% CI 1.56-2.53). Among patients with obesity (BMI ≥30), the risk for discontinuation was particularly notable (pooled risk ratio 2.60, 95% CI 1.65-4.06).

These findings, published in BMJ, highlight the need for further research on GLP-1 receptor agonist use before elective endoscopic procedures. While GLP-1 receptor agonists did not increase pulmonary aspiration risk, the elevated rate of endoscopy discontinuation, especially in patients with obesity, warrants further study to clarify preprocedural recommendations.

Full disclosures can be found in the published study.