Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy
Publication Date: November 7, 2023
Last Updated: November 15, 2023
Summary of Recommendations
There has been increasing concern about performing endoscopic procedures, in particular upper endoscopies, on patients who are using glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1 RAs) due to their effect on slowing gastric motility and the risk of aspiration of retained gastric contents in sedated patients.
Generally, in patients on GLP-1 RAs who have followed standard perioperative procedures (typically an 8-hour solid-food fast and a 2-hour liquid fast) and who do not have symptoms of nausea, vomiting, dyspepsia, or abdominal distention, we advise proceeding with upper and/or lower endoscopy.
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In patients with symptoms suggesting possible retained gastric contents, transabdominal ultrasonography can be utilized to assess the stomach—if there is sufficient clinical expertise and the equipment is available—but evidence to support this modality in standard practice is lacking.
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In symptomatic patients for whom delaying endoscopy may have negative clinical consequences, rapid-sequence intubation is a consideration; however, this may not be possible in most ambulatory or office-based endoscopy settings.
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Lastly, when possible, placing patients on a liquid diet the day before sedated procedures may be a more acceptable strategy, in lieu of stopping GLP-1 RAs, and more consistent with the holistic preprocedural management of other similar conditions.
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In closing, we endorse the GI multi-society guidance that “patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on patients on GLP-1 RAs.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy
Authoring Organization
American Gastroenterological Association
Publication Month/Year
November 7, 2023
Last Updated Month/Year
November 20, 2023
Country of Publication
US
Document Objectives
Experts review the available evidence and provide expert advice regarding the evolving management of patients taking GLP-1 receptor agonists prior to endoscopy.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Management
Diseases/Conditions (MeSH)
D020776 - Endoscopes, Gastrointestinal, D019723 - Endoscopes, D052216 - Glucagon-Like Peptide 1
Keywords
glucagon-like peptide 1 (GLP-1), endoscopy, GLP1, GLP-1
Source Citation
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. 2023 Nov 7:S1542-3565(23)00869-8. doi: 10.1016/j.cgh.2023.11.002. Epub ahead of print. PMID: 37944573.