American Gastroenterological Association’s (AGA) stance on the management of patients taking glucagon-like peptide 1 (GLP-1) receptor agonists before endoscopy procedures.
Summary of the Article:
AGA’s Stance: The AGA has released a rapid clinical practice update in response to the American Society of Anesthesiologists’ recommendation for patients to stop taking GLP-1 receptor agonists (GLP-1 RAs) before elective procedures and surgeries. The AGA does not support the idea of all patients discontinuing these drugs prior to elective endoscopy.
GLP-1 Receptor Agonists: These medications, including Ozempic® (semaglutide) and Trulicity® (dulaglutide), are commonly prescribed for diabetes and obesity treatment. They might slow gastric emptying in some patients, but there is insufficient evidence to make broad recommendations about their management in patients requiring endoscopy.
Individualized Approach: The AGA advocates for a balanced approach, emphasizing patient individualization and safety. They suggest proceeding with endoscopic procedures as planned for patients on GLP-1 RAs who have followed standard pre-procedure fasting instructions and do not exhibit symptoms like nausea or abdominal distention.
Alternative Strategies: Instead of stopping GLP-1 RAs, patients could be placed on a liquid diet one day prior to the procedure. In cases where delaying endoscopy might have negative clinical consequences, rapid-sequence intubation could be considered, although this may not be feasible in all settings.
Overarching Goal: This guidance aims to provide a framework for clinicians to manage GLP-1 RAs in the pre-endoscopy setting, prioritizing the highest standard of care and patient safety.