Summary
The American Gastroenterological Association (AGA) Institute has issued a Rapid Clinical Practice Update (CPU) on managing patients using glucagon-like peptide 1 receptor agonists (GLP-1 RAs) during endoscopic procedures, suggesting that these procedures generally do not need to be postponed for patients without symptoms of gastric retention. This is in contrast to recent guidance from the American Society of Anesthesiologists (ASA), which supports holding GLP-1 RAs before endoscopic surgery, regardless of indication or dosage, due to the potential for delayed gastric emptying and the risk of aspiration. However, the lack of robust evidence prompts varied responses including postponing procedures, contributing to patient waitlists. Moreover, the effectiveness of holding a single dose of GLP-1 RA is unclear and there are concerns about possible hyperglycemia.
The CPU advocates for individualized care, considering factors such as medication indication, dosage, comorbidities, and patient symptoms. For patients showing symptoms of possible retained gastric contents, transabdominal ultrasonography may be considered; however, evidence is limited. If delaying endoscopy could harm symptomatic patients, rapid-sequence intubation may be considered. Alternatively, using a liquid diet the day before the procedure could be considered instead of discontinuing GLP-1 RAs. Collaboration among health care professionals is essential to navigate this clinical dilemma effectively and mitigate potential risks to patient care.
Sources
Hashash JG, Thompson CC, Wang AY. AGA rapid clinical practice update on the management of patients taking GLP-1 receptor agonists prior to endoscopy: communication. Clin Gastroenterol Hepatol. 2024 Apr;22(4):705-707. doi: 10.1016/j.cgh.2023.11.002.
This summary was created with assistance from generative artificial intelligence (ChatGPT, 2024).