Effect of glucagon-like peptide-1 receptor agonists on gastric mucosal visibility during upper endoscopy in Asian patients with diabetes.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being used to treat type 2 diabetes mellitus (T2DM) and obesity. Although GLP-1RAs delay gastric emptying, their impact on gastric mucosal visibility during upper endoscopy remains uncertain, especially in Asian patients. AIM: To investigate the association between GLP-1RA treatment and gastric mucosal visibility during upper endoscopy in Asian patients with T2DM. METHODS: The study population included Korean patients who underwent esophagogastroduodenoscopy (EGD) with concomitant GLP-1RA or dipeptidyl peptidase 4 inhibitor (DPP4i) for the treatment of T2DM. A 1:2 propensity score matching between GLP-1RA and DPP4i users resulted in 198 matched patients and 295 matched patients in each group, respectively. Gastric mucosal visibility was assessed by reviewing endoscopy images with a validated scale (POLPREP). In addition, the rates of aborted and repeat EGD and pulmonary aspiration were also assessed. RESULTS: Of the 493 matched patients, mean body mass index was 26.0 kg/m2. The rate of inadequate gastric mucosal visibility (gastric POLPREP score 0 or 1) was significantly higher in GLP-1RA group than matched DPP4i group (8.6% vs 1.4%, P = 0.0007). The rates of aborted EGD and repeat EGD were also significantly higher in GLP-1RA than DPP4i group (7.6% vs 0.7% in both aborted and repeat EGD, P = 0.0011). Multivariable logistic regression revealed GLP-1RA use as an independent risk factor for both inadequate gastric mucosal visibility (odds ratio = 6.143, 95% confidence interval: 2.289, 20.318, P = 0.0008) and aborted EGD (odds ratio = 11.099, 95% confidence interval: 3.172, 63.760, P = 0.0010). Despite gastric residue, no pulmonary aspiration was reported in either group. CONCLUSION: GLP-1RA use was associated with a higher risk of inadequate gastric mucosal visibility and aborted and repeat procedures during upper gastrointestinal endoscopy in Korean patients with T2DM while pulmonary aspiration was not observed.