OCULUS Trial: Continuing GLP-1/GIP Agonists Before Endoscopy Appears Safe

GLP-1 receptor agonists (like semaglutide) and GLP-1/GIP co-agonists (like tirzepatide) are highly effective for managing type 2 diabetes and obesity. However, a known side effect is delayed gastric emptying, which raises concerns about increased risk of pulmonary aspiration (inhaling stomach contents) during procedures like upper endoscopy, where patients receive sedation. Current guidelines often recommend holding these medications for several days prior to endoscopy. This study, the OCULUS Randomized Clinical Trial, addresses the critical question of whether holding these medications is truly necessary to ensure patient safety during upper endoscopy.

The study found no statistically significant difference in the incidence of pulmonary aspiration between the two groups. The 'holding' group had an aspiration rate of 0.4% (1 out of 260 patients), while the 'continuing' group had a rate of 0.8% (2 out of 260 patients), with a p-value of 0.56. Gastric residual volumes, measured immediately prior to endoscopy, also showed no significant difference, averaging 18.5 mL in the 'holding' group compared to 21.2 mL in the 'continuing' group (p=0.31). Procedure duration and rates of other adverse events were comparable across both cohorts. > The most important finding is that continuing GLP-1/GIP agonists up to the day before upper endoscopy did not significantly increase the risk of pulmonary aspiration or other complications compared to holding the medication for seven days.