A study conducted by the Mayo Clinic, which provides reassurance about the low rate of pulmonary aspiration during upper gastrointestinal (GI) endoscopy in patients taking glucagon-like peptide 1 (GLP-1) receptor agonists. These medications, used for diabetes and obesity treatment, have been associated with delayed gastric emptying, raising concerns about the risk of pulmonary aspiration during upper GI endoscopy.
The study analyzed 4,134 upper GI endoscopies performed in 2,968 unique patients taking a GLP-1 receptor agonist. Researchers used a validated automated electronic search algorithm to identify potential cases of pulmonary aspiration, which were then confirmed through manual chart review.
Only two definite cases of pulmonary aspiration were identified, resulting in a cumulative incidence of 4.8 aspirations per 10,000 procedures. This rate is similar to the rate of 4.6 per 10,000 procedures reported in a 2018 study for those undergoing elective upper GI endoscopy. The two cases involved a middle-aged woman taking dulaglutide for diabetes and an elderly woman taking semaglutide for weight loss. Both cases occurred under monitored anesthesia care, required hospitalization, but the patients recovered and were later discharged.
The study’s findings are significant, especially considering the recent recommendations by the American Society of Anesthesiologists regarding the cessation of daily dosed GLP-1 receptor agonists on the day of the procedure and weekly dosed GLP-1 receptor agonists a week prior to the procedure.
However, the study may underestimate the actual rate of pulmonary aspiration, as cases might have been missed by the search algorithm, and a stringent definition for pulmonary aspiration was used. This definition likely captures the most clinically significant events but may miss subclinical aspiration cases.