TOPLINE:
New data from the Mayo Clinic provide added reassurance that the rate of pulmonary aspiration during upper gastrointestinal (GI) endoscopy is low in patients taking a glucagon-like peptide 1 (GLP-1) receptor agonist.
METHODOLOGY:
- Delayed gastric emptying associated with GLP-1 receptor agonist therapy has raised concern about pulmonary aspiration during upper GI endoscopy.
- Researchers analyzed 4134 upper GI endoscopies performed in 2968 unique patients taking a GLP-1 receptor agonist.
- They identified potential cases of pulmonary aspiration using a validated automated electronic search algorithm, which were then listed as definite after confirmation via subsequent manual chart review.
TAKEAWAY:
- Only two definite cases of pulmonary aspiration were identified, resulting in a cumulative incidence of 4.8 aspirations per 10,000 procedures, similar to the rate of 4.6 per 10,000 procedures in those undergoing elective upper GI endoscopy reported in a 2018 study.
- One case occurred in a middle-aged woman taking dulaglutide for diabetes who had a large amount of food in the stomach and duodenum. She developed an episode of vomiting and massive aspiration upon endoscope removal.
- The other case involved an elderly woman taking semaglutide for weight loss, who presented with persistent hypoxemia after the procedures and had radiographic findings consistent with pulmonary aspiration.
- Both cases occurred under monitored anesthesia care rather than general endotracheal anesthesia. The patients required hospitalization, recovered, and were later discharged.
IN PRACTICE:
“These findings should be taken into consideration, particularly in view of the recent recommendations by the American Society of Anesthesiologists to stop a daily dosed GLP-1 receptor agonist on the day of the procedure and a weekly dosed GLP-1 receptor agonist a week prior to the procedure,” the authors wrote.
SOURCE:
The study, with first author Diego Anazco, MD, Mayo Clinic, Rochester, Minnesota, was published online on December 1, 2023, in Clinical Gastroenterology and Hepatology.
LIMITATIONS:
The results may underestimate the actual rate of pulmonary aspiration. Cases may have been missed by the search algorithm, and a stringent definition for pulmonary aspiration was used (presence of bilious or particulate matter in the airway during visual exam and/or postprocedural presence of new pulmonary infiltrates), which likely captures the most clinically significant events but may miss subclinical aspiration cases.
DISCLOSURES:
The study received no specific funding. Corresponding author Andres Acosta, MD, PhD, holds stock in Gila Therapeutics and Phenomix Sciences and has consulted for Rhythm Pharmaceuticals and Amgen Pharmaceuticals. The remaining authors disclosed no conflicts.
Source link : https://www.medscape.com/viewarticle/low-rate-aspiration-glp-1s-during-upper-gi-endoscopy-2024a10000mi?src=rss
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Publish date : 2024-01-10 06:54:01
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