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Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study

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World Journal of Gastroenterology 2024年第26期30卷 3221-3228页

作者： Haider Ghazanfar Nismat Javed Abeer Qasim Franklin Sosa Faryal Altaf Shazia Khan Jaydeep Mahasamudram Abhilasha Jyala Sameer Datta Kandhi Dongmin Shin Nikhitha Mantri Haozhe Sun siddarth hanumanthu Harish Patel Jasbir Makker Bhavna Balar Anil Dev Sridhar Chilimuri Division of Gastroenterology Department of Internal MedicineBronxCare Health SystemIcahn School of Medicine at Mount SinaiBronxNY 10457United States Department of Internal Medicine BronxCare Health SystemIcahn School of Medicine at Mount SinaiBronxNY 10457United States

BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1 RA)are effective in diabetes and obesity,reducing hyperglycemia by increasing insulin release and delaying gastric ***,they can cause gastroparesis,raising concerns about aspiration during *** guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary *** To evaluate the effect of GLP-1 RAs on gastric residual contents during endosco-pic *** A retrospective chart review at BronxCare Health System,New York,from January 2019 to October 2023,assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic *** groups were compared based on dietary status before the *** included demographics,symptoms of gastroparesis,opiate use,hemoglobin A1c,GLP-1 agonist indication,endo-scopic details,and aspiration *** SPSS was used for analysis,cal-culating means,standard deviations,and applying Pearson’s chi-square and t-tests for associations,with P<0.05 as being *** During the study,306 patients were included,with 41.2%on a clear liquid/low residue diet and 58.8%on a regular diet before *** patients(63.1%)were male,with a mean age of 60±12 *** majority(85.6%)were on GLP-1 RAs for diabetes,and 10.1%reported digestive symptoms before *** those on a clear liquid diet,1.5%had residual food at endoscopy compared to 10%on a regular diet,which was statistically significant(P=0.03).Out of 31 patients with digestive symptoms,13%had residual food,all from the regular diet group(P=0.130).No complications were reported during or after the *** The study reflects a significant rise in GLP-1 RA use for diabetes and obesity.A 24-hour liquid diet seems safe for endoscopic procedures without *** with upper gastrointestinal symptoms might have a higher residual food risk,though not statistically *** research is needed

关键词： Glucagon-like peptide-1 agonists Gastroparesis Endoscopic procedures Residual food Complications

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Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

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World Journal of Gastrointestinal Surgery 2021年第11期13卷 1436-1447页

作者： Danial Haris Shaikh Harish Patel Rezwan Munshi Haozhe Sun Shehriyar Mehershahi Ahmed Baiomi Ahmed Alemam Usman Pirzada Iqra Nawaz Kamrun Naher siddarth hanumanthu Suresh Nayudu Division of Gastroenterology Department of MedicineBronxCare Health SystemBronxNY 10457United States Department of Medicine Nassau University Medical CenterNew YorkNY 11554United States Department of Medicine BronxCare Health SystemBronxNY 10457United States

BACKGROUND Clostridium difficile infection(CDI)occurs due to a dysbiosis in the *** appendix is considered a‘safe house’for gut microbiota and may help repopulate gut flora of patients with *** To study the impact of prior appendectomy on the severity and outcomes of *** We retrospectively reviewed data of 1580 patients with CDI,admitted to our hospital between 2008 to *** were grouped based on the presence or absence of the *** primary aim was to(1)assess all-cause mortality and(2)the severity of *** was defined as per the Infectious Diseases Society of America *** regression,and propensity score analysis using inverse probability of treatment weights(IPTW)was *** Of the 1580 patients,12.5%had a history of *** was no statistical difference in mortality between patients with a prior appendectomy or without(13.7%vs 14%,P=0.877).However,a history of appendectomy affected the severity of CDI[odds ratio(OR)=1.32,95%confidence interval:1.01-1.75].On IPTW,this association remained significant(OR=1.59,P<0.05).On multivariable toxic megacolon(OR=5.37,P<0.05)and colectomy(OR=2.77,P<0.05).CONCLUSION Prior appendectomy may affect the severity of CDI,development of toxic megacolon and the eventual need for *** treatment of CDI is governed by its severity,stronger antibiotic regimens or earlier use of fecal microbiota transplant may be a viable option for patients with prior appendectomy.

关键词： Appendectomy Clostridium difficile Toxic megacolon Colectomy Gut microbiome

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