AGA has released a rapid clinical practice update addressing the management of patients taking glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1 RAs) prior to endoscopy. Published in Clinical Gastroenterology and Hepatology, AGA finds 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.
GLP-1 RAs — including Ozempic® (semaglutide), Trulicity® (dulaglutide), among others — are commonly prescribed medications used to treat patients with diabetes and/or obesity.
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 prioritizing patient safety.
This guidance further reinforces the GI multi-society statement released in August 2023 in response to the American Society of Anesthesiologists.
