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

Table 1 Characteristics of glucagon-like peptide-1 receptor agonist users and dipeptidyl peptidase 4 inhibitor users before and after matching, n (%)

Characteristic	Before matching (n = 733)					After matching (n = 493)
	Total (n = 733)	GLP-1RA (n = 208)	DPP4i (n = 525)	ASMD	P value	Total (n = 493)	GLP-1RA (n = 198)	DPP4i (n = 295)	ASMD	P value
Age (years)	64.2 ± 10.4	61.2 ± 10.9	65.5 ± 9.9	0.4119	< 0.0001	62.1 ± 10.2	61.6 ± 10.8	62.3 ± 9.7	0.067	0.4702
Sex (male)	471 (64.3)	133 (63.9)	338 (64.4)	0.0091	0.9791	320 (64.9)	129 (65.2)	191 (64.7)	0.0085	0.9263
BMI (kg/m2)	25.4 ± 3.79	26.4 ± 3.82	25.0 ± 3.71	0.3731	< 0.0001	26.0 ± 3.74	26.3 ± 3.85	25.8 ± 3.66	0.1314	0.1504
HbA1c (%)	7.10 ± 1.22	7.53 ± 1.27	6.93 ± 1.15	0.4907	< 0.0001	7.30 ± 1.16	7.42 ± 1.17	7.23 ± 1.16	0.1665	0.0754
Insulin use	165 (22.5)	70 (33.7)	95 (18.1)	0.361	< 0.0001	138 (28)	63 (31.8)	75 (25.4)	0.1418	0.1217
DM complication	266 (36.3)	83 (39.9)	183 (34.9)	0.1045	0.2317	177 (35.9)	78 (39.4)	99 (33.6)	0.1214	0.1859
Low eGFR	128 (17.5)	17 (8.2)	111 (21.1)	0.373	< 0.0001	44 (8.9)	17 (8.6)	27 (9.2)	0.0199	0.8287
Hypertension	422 (57.6)	121 (58.2)	301 (57.3)	0.017	0.9009	279 (56.6)	115 (58.1)	164 (55.6)	0.0502	0.5849
Cardiovascular disease	72 (9.8)	23 (11.1)	49 (9.3)	0.057	0.569	51 (10.3)	20 (10.1)	31 (10.5)	0.0134	0.8842
Cerebrovascular accident	41 (5.6)	15 (7.2)	26 (5.0)	0.0946	0.3069	27 (5.5)	13 (6.6)	14 (4.7)	0.0788	0.3859
Gastric modulator
Increasing motility1	27 (3.7)	7 (3.4)	20 (3.8)	0.0239	0.9439	12 (2.4)	7 (3.5)	5 (1.7)	0.1155	0.2034
Decreasing motility2	18 (2.5)	4 (1.9)	14 (2.7)	0.0497	0.7917	13 (2.6)	4 (2.0)	9 (3.1)	0.0656	0.4869

¹Gastric modulators increasing motility included prokinetic agents.

²Gastric modulators decreasing motility included tricyclic antidepressants, opioid medications, and anticholinergic agents.

GLP-1RA: Glucagon-like peptide-1 receptor agonist; DPP4i: Dipeptidyl peptidase 4 inhibitor; ASMD: Absolute standardized mean difference; BMI: Body mass index; DM: Diabetes mellitus; eGFR: Estimated glomerular filtration rate; HbA1c: Hemoglobin A1c.

Table 2 Procedural outcomes of glucagon-like peptide-1 receptor agonist users and dipeptidyl peptidase 4 inhibitor users before and after matching, n (%)

Characteristic	Before matching (n = 733)				After matching (n = 493)
	Total (n = 733)	GLP-1RA (n = 208)	DPP4i (n = 525)	P value	Total (n = 493)	GLP-1RA (n = 198)	DPP4i (n = 295)	P value
Inadequate gastric mucosal visibility	27 (3.7)	19 (9.1)	8 (1.5)	< 0.0001	21 (4.3)	17 (8.6)	4 (1.4)	0.0007
Aborted EGD	21 (2.9)	16 (7.7)	5 (1.0)	< 0.0001	17 (3.4)	15 (7.6)	2 (0.7)	0.0011
Repeat EGD	21 (2.9)	16 (7.7)	5 (1.0)	< 0.0001	17 (3.4)	15 (7.6)	2 (0.7)	0.0011
Pulmonary aspiration	0 (0.0)	0 (0.0)	0 (0.0)	NA	0 (0.0)	0 (0.0)	0 (0.0)	NA

GLP-1RA: Glucagon-like peptide-1 receptor agonist; DPP4i: Dipeptidyl peptidase 4 inhibitor; EGD: Esophagogastroduodenoscopy; NA: Not applicable.

Table 3 Multivariate analysis of risk factors for inadequate gastric mucosal visibility

Characteristic	Propensity matched patients (n = 493)
	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
GLP-1RA	6.105 (2.294-20.055)	0.0008	6.143 (2.289-20.318)	0.0008
Age	0.974 (0.936-1.015)	0.2025	-	-
Sex (male)	0.845 (0.353-2.127)	0.7083	-	-
BMI	1.104 (0.993-1.222)	0.0598	1.086 (0.973-1.207)	0.1285
HbA1c	1.053 (0.725-1.471)	0.7759	-	-
Insulin use	0.939 (0.335-2.332)	0.8961	-	-
DM complication	1.710 (0.710-4.115)	0.2250	-	-
Low eGFR	3.423 (1.045-9.392)	0.0248	3.072 (0.896-8.978)	0.0516
Hypertension	0.684 (0.282-1.636)	0.3893	-	-
Cardiovascular disease	2.278 (0.682-6.238)	0.1355	-	-
Cerebrovascular accident	1.296 (0.139-5.432)	0.7668	-	-
Gastric modulator
Increasing motility1	0.876 (0.050-15.311)	0.9275	-	-
Decreasing motility2	1.767 (0.095-9.584)	0.5922	-	-

¹Gastric modulators increasing motility included prokinetic agents.

²Gastric modulators decreasing motility included tricyclic antidepressants, opioid medications, and anticholinergic agents.

OR: Odds ratio; CI: Confidence interval; GLP-1RA: Glucagon-like peptide-1 receptor agonist; BMI: Body mass index; DM: Diabetes mellitus; eGFRl: Estimated glomerular filtration rate; HbA1c: Hemoglobin A1c.

Table 4 Multivariate analysis of risk factors for aborted esophagogastroduodenoscopy

Characteristic	Propensity matched patients (n = 493)
	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
GLP-1RA	10.738 (3.122-61.014)	0.0010	11.099 (3.172-63.760)	0.0010
Age	0.973 (0.932-1.019)	0.2313	-	-
Sex (male)	0.715 (0.272-1.959)	0.4988	-	-
BMI	1.142 (1.018-1.276)	0.0201	1.121 (0.994-1.259)	0.0555
HbA1c	1.118 (0.746-1.603)	0.5653	-	-
Insulin use	1.003 (0.322-2.726)	0.9951	-	-
DM complication	1.979 (0.749-5.338)	0.1656	-	-
Low eGFR	4.628 (1.377-13.324)	0.0068	4.137 (1.153-12.992)	0.0191
Hypertension	1.120 (0.426-3.121)	0.8204	-	-
Cardiovascular disease	3.066 (0.896-8.797)	0.0490	-	-
Cerebrovascular accident	1.660 (0.176-7.124)	0.5652	-	-
Gastric modulator
Increasing motility1	1.095 (0.062-19.281)	0.9507	-	-
Decreasing motility2	2.249 (0.120-12.428)	0.4484	-	-

¹Gastric modulators increasing motility included prokinetic agents.

²Gastric modulators decreasing motility included tricyclic antidepressants, opioid medications, and anticholinergic agents.

OR: Odds ratio; CI: Confidence interval; GLP-1RA: Glucagon-like peptide-1 receptor agonist; BMI: Body mass index; DM: Diabetes mellitus; eGFR: Estimated glomerular filtration rate; HbA1c: Hemoglobin A1c.