S893 The Impact of GLP-1 Receptor Agonists on Retained Gastric Contents, Aborted Procedures, and Aspiration During Esophagogastroduodenoscopy: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for treating type 2 diabetes mellitus (T2DM) and obesity, and are being explored for other conditions. Their effect on delaying gastric emptying raises concerns regarding retained gastric contents (RGC), perioperative pulmonary aspiration (PA), particularly during esophagogastroduodenoscopy (EGD). We aimed to systematically review and conduct a meta-analysis of the association between GLP-1RA use and the incidence of gastric retained contents (RGC), incomplete EGD, repeat EGD, and procedure-related adverse events (AEs). Methods: We searched PubMed, MEDLINE via Ovid, Embase via Elsevier, Web of Science, Scopus and Cochrane library from their inception to May 23, 2024. Trial registries were searched until the same date. We included studies of participants aged 18 years or older who underwent EGD while taking GLP-1RAs, if incidence of the outcomes could be calculated. At least 2 reviewers independently screened and selected the studies, extracted data on study design, patient characteristics, and outcomes, and assessed the risk of bias using the Newcastle-Ottawa Scale. Results: We included 29 studies (n=137,614 patients; 44,101 GLP-1RA users). Twenty-four studies evaluated the use of any GLP-1RA while 5 focused on once-weekly GLP-1RA. GLP-1RA use was associated with a higher prevalence of RGC (14.08% vs. 2.99%; OR, 5.07, 95% CI: 3.74-6.87), particularly solid contents (21.58% vs. 2.55%, OR: 4.89, 95% CI: 2.67-8.69). GLP-1RAs increased the risk of aborted procedures (1.42% vs. 0.17%; OR, 4.76, 95% CI: 2.76-8.14). The aspiration frequency was numerically higher in the GLP-1RA group (127/38,365 cases) compared to the non-GLP1-RA group (96/51,129 cases), but not statistically significant (OR: 1.53, 95% CI: 0.92-2.56). Conclusion: Our study highlighted 3 key dimensions related to the clinical implications of delayed gastric emptying from GLP-1 receptor agonist (GLP-1 RA) use. Firstly, we noted a significantly higher incidence and risk of retained gastric contents (RGC) in patients treated with GLP-1 RA agents. Despite this increase, the elevated RGC did not correspond to a rise in aspiration-related adverse effects. However, the increased incidence of RGC was clinically significant as it led to more aborted procedures. Additionally, RGC compromised the effectiveness of the procedures by obscuring the gastric mucosa, which is essential for accurately diagnosing small lesions (Figure 1, Table 1).Figure 1.: The odds ratio (OR) for the occurrence of RGC in the GLP-1RA group compared to the control group by visualization methods. Random effects REML Model, Sorted by year of publication. Table 1. - Summary of pooled estimates Pooled Estimates 95% CI I2 (%) Gastric Retained Contents Prevalence in GLP-1RA Group (%) 14.08 9.06-19.93 96.80% Prevalence in Control Group (%) 2.99 1.68-4.59 95.67% Odds Ratio 5.07 3.74-6.87 63.86% Solid Gastric Retained Contents Prevalence in GLP-1RA Group (%) 21.58 2.03-51.95 99.20% Prevalence in Control Group (%) 2.55 0.52-5.58 59.55% Odds Ratio 4.89 2.67-8.69 0.00% Aborted Procedures Prevalence in GLP-1RA Group (%) 1.42 0.86-2.09 51.91% Prevalence in Control Group (%) 0.17 0.0-0.73 97.47% Odds Ratio 4.76 2.76-8.14 20.11% Aspiration Prevalence in GLP-1RA Group (%) 0.0 0.0-0.11 83.62% Prevalence in Control Group (%) 0.0 0.0-0.00 95.99% Odds Ratio 1.53 0.92-2.56 3.68%
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.031 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".