Preoperative Fasting Status and Retained Gastric Content in Patients Receiving Glucagon-Like Peptide Type 1 Receptor Agonists: A Retrospective Study

Document Type

Conference Proceeding

Publication Date

5-1-2025

Publication Title

Anesth Analg

Keywords

Anesthesiology

Abstract

Introduction: Glucagon-like peptide type 1 receptor agonists (GLP-1RA) are antihyperglycemic drugs indicated to treat Type 2 Diabetes Mellitus (T2DM) and obesity1, 2. GLP-1RAs are notable for causing delayed gastric emptying (DGE), which may increase the risk of aspiration during general anesthesia1, 3 4. To date, there is scant data exploring the association between the type and duration of preprocedural fasting with DGE in patients receiving GLP-1RAs. We aimed to study the association between preoperative fasting and retained gastric content (RGC) in patients on GLP-1RA undergoing esophagogastroduodenoscopy (EGD).Methods: Retrospective, multi-center cohort study including patients with an active GLP-1RA prescription who underwent EGD from January 1, 2018, to December 31, 2023. Exclusion criteria included a previous diagnosis of gastroparesis, neuromuscular disease, bariatric surgery, or gastrointestinal malignancy. This study was approved by the Henry Ford Health Institutional Review Board (IRB#: 16959). Demographic information, medical history, GLP-1RA usage, fasting status (including time of last solid and liquid intake), and procedure details were extracted from the electronic health records. The primary outcome was the presence of RGC confirmed during EGD, defined as any small, moderate, or large amount of food or gastric content specifically reported by the endoscopist. The effect of preoperative fasting was analyzed using a multivariable logistic regression model adjusting for confounding variables (days between the last dose taken and EGD date, and diagnosis of diabetes). We also divided the study population into four groups based on the quartiles of GLP-1RA onset times, and then the data was analyzed using Spearman’s rank test. Results: In the six-year period, a total of 43,777 EGDs were performed. Of these, 2,391 procedures involved patients who had a GLP-1RA prescription. Only 337 EGDs were conducted on patients who had a GLP-1RA prescription within 90 days before the procedure date. Table 1 describes the baseline characteristics of the study. The prevalence of RGC was 8.4%. The multivariable logistic regression model showed that fasting for solid foods for 24 hours or more was associated with a reduced likelihood of RGC (adjusted OR: 0.32, 95% CI 0.10-0.99, P=0.049). Discontinuing GLP-1RA for 30 days or less before the procedure did not affect the risk of RGC after EGD (adjusted OR: 0.94, 95% CI: 0.83-1.08, P=0.406). The prevalence of retained gastric content among the quartiles of GLP-1RA onset times was 7.6% in Q1 (11 days to 3.6 months), 7.8% in Q2 (3.7 months to 11.7 months), 9.0% in Q3 (11.8 months to 1.9 years), and 9.1% in Q4 (> 1.9 years). The association between RGC and the onset of GLP-1RA per quartile was examined with a Spearman’s rank test, which showed a weak correlation between both variables (ρ: 0.020, p-value 0.711).Conclusions: Prolonged fasting from solids (>24 hours) is necessary among patients with an active prescription for GLP 1RA to reduce the risk of RGC. The time between the last dose of GLP-1RA and the procedure did not seem to affect the risk of RGC. Further studies with larger sample size are needed to assess the association of the onset time of GLP-1RA with RGC.

Volume

140

Issue

5

First Page

1047

Last Page

1048

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