Current Evidence On GLP-1 Receptor Agonists: Impact On Residual Gastric Content and Endoscopy Quality

Abstract

McKenna Andrews MD, Hezborn Magacha MD, MPH, David Berry DO, Sagar Nagpal MD, Mark F Young MD and Venkata Vedantam MD

Glucagon-like peptide-1 (GLP-1) receptor agonists, introduced in 2005, have become crucial in managing type 2 diabetes mellitus (T2DM) by regulating gastrointestinal motility and metabolic disorders. These agents, including exenatide and liraglutide, effectively lower HbA1c levels, reduce body weight, and minimize hypoglycemia risk by mimicking the endogenous incretin hormone GLP-1. GLP-1 receptor agonists enhance insulin secretion, inhibit glucagon release, and promote satiety, which aids in glucose homeostasis and weight management. Additionally, these agonists provide cardiovascular benefits, reducing the risk of major adverse cardiovascular events in T2DM patients. The primary mechanism of action involves delaying gastric emptying by modulating smooth muscle contractions and inhibiting gastric secretions, thus helping flatten postprandial glucose spikes and enhance satiety. This delay in gastric emptying has significant clinical implications, especially during endoscopic procedures, as it increases residual gastric contents, potentially complicating visualization and increasing the risk of aspiration. Studies have shown that patients on GLP-1 receptor agonists exhibit higher residual gastric volumes, necessitating adjustments in fasting guidelines before endoscopy. Additionally, GLP-1 receptor agonists may affect bowel preparation quality during colonoscopy, leading to suboptimal visualization and increased procedural complications. Consequently, clinicians are advised to consider protocol adjustments, such as extended fasting periods and alternative bowel preparation regimens, to optimize endoscopic outcomes and minimize risks in patients on GLP-1 therapy. These findings underscore the need for individualized patient management and careful assessment of GLP-1 receptor agonist use in clinical practice.

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