PDF(Pubmed)
Abstract：
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective in diabetes and obesity, reducing hyperglycemia by increasing insulin release and delaying gastric emptying. However, they can cause gastroparesis, raising concerns about aspiration during procedures. Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration.
OBJECTIVE: To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures.
METHODS: A retrospective chart review at BronxCare Health System, New York, from January 2019 to October 2023, assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures. Two groups were compared based on dietary status before the procedure. Data included demographics, symptoms of gastroparesis, opiate use, hemoglobin A1c, GLP-1 agonist indication, endoscopic details, and aspiration occurrence. IBM SPSS was used for analysis, calculating means, standard deviations, and applying Pearson\'s chi-square and t-tests for associations, with P < 0.05 as being significant.
RESULTS: During the study, 306 patients were included, with 41.2% on a clear liquid/low residue diet and 58.8% on a regular diet before endoscopy. Most patients (63.1%) were male, with a mean age of 60 ± 12 years. The majority (85.6%) were on GLP-1 RAs for diabetes, and 10.1% reported digestive symptoms before endoscopy. Among those on a clear liquid diet, 1.5% had residual food at endoscopy compared to 10% on a regular diet, which was statistically significant (P = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications were reported during or after the procedures.
CONCLUSIONS: The study reflects a significant rise in GLP-1 RA use for diabetes and obesity. A 24-hour liquid diet seems safe for endoscopic procedures without aspiration. Patients with upper gastrointestinal symptoms might have a higher residual food risk, though not statistically significant. Further research is needed to assess risks based on diabetes duration, gastroparesis, and GLP-1 RA dosing, aiming to minimize interruptions in therapy during procedures.
OBJECTIVE: To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures.
METHODS: A retrospective chart review at BronxCare Health System, New York, from January 2019 to October 2023, assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures. Two groups were compared based on dietary status before the procedure. Data included demographics, symptoms of gastroparesis, opiate use, hemoglobin A1c, GLP-1 agonist indication, endoscopic details, and aspiration occurrence. IBM SPSS was used for analysis, calculating means, standard deviations, and applying Pearson\'s chi-square and t-tests for associations, with P < 0.05 as being significant.
RESULTS: During the study, 306 patients were included, with 41.2% on a clear liquid/low residue diet and 58.8% on a regular diet before endoscopy. Most patients (63.1%) were male, with a mean age of 60 ± 12 years. The majority (85.6%) were on GLP-1 RAs for diabetes, and 10.1% reported digestive symptoms before endoscopy. Among those on a clear liquid diet, 1.5% had residual food at endoscopy compared to 10% on a regular diet, which was statistically significant (P = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications were reported during or after the procedures.
CONCLUSIONS: The study reflects a significant rise in GLP-1 RA use for diabetes and obesity. A 24-hour liquid diet seems safe for endoscopic procedures without aspiration. Patients with upper gastrointestinal symptoms might have a higher residual food risk, though not statistically significant. Further research is needed to assess risks based on diabetes duration, gastroparesis, and GLP-1 RA dosing, aiming to minimize interruptions in therapy during procedures.
摘要：
背景：胰高血糖素样肽-1受体激动剂（GLP-1RA）对糖尿病和肥胖症有效，通过增加胰岛素释放和延迟胃排空来减少高血糖。然而,它们会导致胃轻瘫，在手术过程中引起人们对愿望的担忧。最近的指南建议在手术前停止GLP-1RA，以降低肺吸入的风险。
目的：评价GLP-1RAs对胃镜下残余内容物的影响。
方法：BronxCare卫生系统的回顾性图表回顾，纽约,从2019年1月至2023年10月,我们评估了接受内镜手术的GLP-1RA患者的胃残留和误吸.根据手术前的饮食状况对两组进行比较。数据包括人口统计，胃轻瘫的症状,阿片类药物的使用,血红蛋白A1c，GLP-1激动剂适应症，内窥镜细节,和误吸发生。IBMSPSS用于分析，计算手段，标准偏差，并应用皮尔逊卡方检验和t检验进行关联，P<0.05为显著。
结果：在研究期间，包括306名患者，在内窥镜检查前，41.2％的饮食是透明的液体/低残留饮食，58.8％的饮食是常规饮食。大多数患者（63.1%）为男性，平均年龄60±12岁。大多数（85.6％）在GLP-1RA用于糖尿病，10.1%的患者在内窥镜检查前报告了消化症状。在那些清流饮食的人中，1.5％的人在内窥镜检查时残留食物，而常规饮食为10％。有统计学意义(P=0.03)。31例有消化症状的病人中,13%有残留食物，均来自常规饮食组（P=0.130）。术中或术后均未报告并发症。
结论：该研究反映了GLP-1RA用于糖尿病和肥胖症的显著增加。对于没有抽吸的内窥镜手术，24小时流质饮食似乎是安全的。有上消化道症状的患者可能有更高的残留食物风险，虽然没有统计学意义。需要进一步的研究来评估基于糖尿病持续时间的风险，胃轻瘫,和GLP-1RA给药，旨在尽量减少手术过程中的治疗中断。
目的：评价GLP-1RAs对胃镜下残余内容物的影响。
方法：BronxCare卫生系统的回顾性图表回顾，纽约,从2019年1月至2023年10月,我们评估了接受内镜手术的GLP-1RA患者的胃残留和误吸.根据手术前的饮食状况对两组进行比较。数据包括人口统计，胃轻瘫的症状,阿片类药物的使用,血红蛋白A1c，GLP-1激动剂适应症，内窥镜细节,和误吸发生。IBMSPSS用于分析，计算手段，标准偏差，并应用皮尔逊卡方检验和t检验进行关联，P<0.05为显著。
结果：在研究期间，包括306名患者，在内窥镜检查前，41.2％的饮食是透明的液体/低残留饮食，58.8％的饮食是常规饮食。大多数患者（63.1%）为男性，平均年龄60±12岁。大多数（85.6％）在GLP-1RA用于糖尿病，10.1%的患者在内窥镜检查前报告了消化症状。在那些清流饮食的人中，1.5％的人在内窥镜检查时残留食物，而常规饮食为10％。有统计学意义(P=0.03)。31例有消化症状的病人中,13%有残留食物，均来自常规饮食组（P=0.130）。术中或术后均未报告并发症。
结论：该研究反映了GLP-1RA用于糖尿病和肥胖症的显著增加。对于没有抽吸的内窥镜手术，24小时流质饮食似乎是安全的。有上消化道症状的患者可能有更高的残留食物风险，虽然没有统计学意义。需要进一步的研究来评估基于糖尿病持续时间的风险，胃轻瘫,和GLP-1RA给药，旨在尽量减少手术过程中的治疗中断。
