Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period (Clinical GI & Hepatology)

The recent multisociety clinical practice document provides guidance on the perioperative management of GLP-1 receptor agonists (GLP-1RAs), emphasizing shared decision-making and tailored patient care. Here are key points from the recommendations:

1. Risk Assessment for Gastric Emptying and Aspiration: Care teams should consider factors that increase the risk of delayed gastric emptying, such as being in the dose escalation phase, high doses, weekly dosing schedules, presence of gastrointestinal symptoms, and other medical conditions that could slow gastric emptying (e.g., gastroparesis).
2. Decision to Continue or Hold GLP-1RAs: GLP-1RAs may be continued perioperatively for patients without heightened risk of aspiration. However, for those with elevated risk, withholding the medication must be balanced against potential metabolic issues like hyperglycemia and the feasibility of implementing bridging therapies, which could be costly and complex.