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Clinical Practice Update

Management of patients taking GLP-1 receptor agonists prior to endoscopy

Experts review the available evidence and provide expert advice regarding the evolving management of patients taking GLP-1 receptor agonists prior to endoscopy.

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Summary

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. In patients with symptoms suggesting possible retained gastric contents, transabdominal ultrasonography can be utilized to assess the stomachā€”if there is sufficient clinical expertise and the equipment is availableā€”but evidence to support this modality in standard practice is lacking. 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. 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. In closing, we endorse the GI multi-society guidance that ā€œpatient 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.

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