Gastroenterologists oppose ‘blanket ban’ on GLP-1 RAs before endoscopy

Type 2 diabetes

By Michael Woodhead

21 Nov 2023

The American Gastroenterological Association (AGA) has come out in opposition to advice from anaesthetists over the routine cessation of glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1 RAs) prior to endoscopy.

While recognising that GLP-1 RAs may increase the risk of gastroparesis, the AGA has released a rapid clinical practice update saying there is no data to support all patients stopping GLP-1 RAs prior to elective endoscopy procedures.

“This guidance is in response to American Society of Anesthesiologists’ call for patients to stop taking GLP-1 RAs prior to elective procedures and surgeries,” it said in a statement published in Clinical Gastroenterology and Hepatology, on 7 November.

The AGA said the issue of GI risks with GLP-1 RAs had come to the fore with the increasing use of agents such as semaglutide (Ozempic) and dulaglutide (Trulicity) to treat patients with diabetes and/or obesity.

It noted there had been increasing concern about performing endoscopic procedures, in particular upper endoscopies, on patients who are using GLP-1 RAs due to their effect on slowing gastric motility and the risk of aspiration of retained gastric contents in sedated patients.

“While GLP-1 RAs might slow gastric emptying in some patients, there is overall insufficient evidence for ‘blanket statements’ on how to manage patients taking these medications who require endoscopy,” said guidance author Professor Andrew Wang of the Division of Gastroenterology and Hepatology, University of Virginia.

“AGA’s clinical practice update advocates for a balanced approach and supports patient individualisation, encouraging physicians to be cautious, putting the patient’s safety first,” concluded author Dr Jana Al Hashash, a gastroenterologist at the Mayo Clinic Jacksonville.

AGA suggests the following considerations when treating patients on GLP-1 RAs undergoing endoscopic procedures:

  • Proceed with the procedure as planned for patients on GLP-1 RAs who followed the standard pre-procedure fasting instructions (no food for eight hours and no liquids for two hours before the procedure) and who do not have nausea, vomiting, dyspepsia or abdominal distention.
  • In lieu of stopping GLP-1 RAs, patients can also be placed on a liquid diet one day prior to their procedure.
  • In patients, with symptoms suggesting retained gastric contents, for whom delaying endoscopy may have negative clinical consequences, consider rapid-sequence intubation. However, this may not be possible in most ambulatory or office-based endoscopy settings.

“Ultimately, this rapid clinical practice update provides a framework for clinicians to navigate the complexities of managing GLP-1 RAs in the pre-endoscopy setting, with the overarching goal of delivering the highest standard of care and prioritising patient safety.

The AGA said the new guidance further reinforces the GI multi-society statement released in August 2023 in response to the American Society of Anesthesiologists.

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