The American Gastroenterological Association (AGA) has updated its clinical practice guidelines, opposing the recommendation to stop glucagon-like peptide-1 receptor agonists (GLP-1 agonists) prior to elective endoscopy procedures. This stance is in response to the American Society of Anesthesiologists’ (ASA) consensus-based perioperative guidance, which suggested discontinuing GLP-1 agonists before any endoscopy procedures.
AGA’s guidance emphasizes the lack of high-level published evidence supporting the ASA’s recommendation. Andrew Y. Wang, MD, from the University of Virginia, highlighted that anesthesia providers were using the ASA guidance to cancel or postpone endoscopic procedures for patients who did not stop their GLP-1 agonist medication. This approach failed to consider the potential harm of withholding the medication, especially for patients using it to treat diabetes.
The AGA advises clinicians to be aware of a patient’s reasons for taking GLP-1 agonists, considering factors like dose, frequency, comorbidities, and potential gastrointestinal side effects. The concern is particularly relevant for upper endoscopies, due to the effect of GLP-1 agonists on slowing gastric motility and the risk of aspiration. However, it’s unclear if skipping a single dose before an endoscopy is adequate for normalizing gastric motility. For patients using GLP-1 agonists for weight loss, skipping a dose before endoscopy might be harmless but isn’t considered mandatory or evidence-based. For diabetic patients, there’s insufficient evidence to support holding a dose, as good glycemic control is necessary before sedation and endoscopy.
The AGA suggests that patients on GLP-1 agonists who adhere to standard perioperative procedures, including fasting protocols, and show no symptoms of nausea or abdominal distention, could proceed with endoscopy. They also propose using transabdominal ultrasonography to examine the stomach for retained contents, although evidence supporting this practice is limited.
In conclusion, the AGA emphasizes the need for individualized treatment and the use of clinical judgment in pre-procedural and peri-procedural management, rather than strictly adhering to the ASA’s perioperative guidance, which is based more on expert opinion than on solid evidence.