Glucagon-like peptide-1 receptor agonist and respiratory complications after endoscopy: A Japanese nationwide cohort study.

Abstract

Aims: While discontinuation of glucagon-like peptide-1 receptor agonists (GLP-1RAs) before esophagogastroduodenoscopy (EGD) is not universally mandated, safety concerns persist. Evidence remains insufficient for managing specific patient subgroups, particularly in Asian populations. We aimed to provide evidence for stratified risk assessment in a large Japanese cohort.

Materials and methods: This nationwide retrospective cohort study used the Japan Medical Data Center database. We performed 1:4 propensity score matching based on age, sex, insulin use, HbA1c level, chronic respiratory disease, and body mass index to compare patients with diabetes receiving GLP-1RAs (n = 3568) with non-users (n = 14 246). Respiratory and severe complications within 14 days post-EGD were assessed via logistic regression.

Results: GLP-1RA was not associated with an increased risk of overall (0.39% vs. 0.50%; odds ratio [OR] 0.79, 95% confidence interval [CI] 0.44-1.40; p = 0.41) or severe (0.11% vs. 0.077%; 1.45, 0.46-4.56; p = 0.52) respiratory complications. While no subgroup analysis reached statistical significance, numerical trends towards a higher risk were observed in new users (OR 1.43; 95% CI, 0.51-3.98) and patients with severe diabetes (OR 1.28; 95% CI, 0.64-2.52).

Conclusions: GLP-1RA was not associated with increased post-EGD respiratory complications, suggesting that routine discontinuation may be unnecessary for many stable, long-term users. However, our findings do not support a uniform conclusion of safety for all subgroups. The non-significant trends in new users and patients with severe diabetes warrant a cautious, individualised approach for these potentially vulnerable populations. Further research is needed to definitively clarify this risk.