GI societies: ‘Little or no data’ linking GLP-1 agonists to safety issues during endoscopy
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In response to safety concerns surrounding sedation for patients prescribed glucagon-like peptide-1 receptor agonists, the AGA, AASLD, ACG, ASGE and NASPGHAN encourage gastroenterologists to follow “best practices” for endoscopy procedures.
The use of glucagon-like peptide-1 (GLP-1) receptor agonists for diabetes and weight loss management – including semaglutide (Ozempic/ Rybelsus/ Wegovy, Novo Nordisk), tirzepatide (Mounjaro, Eli Lilly), exenatide (Byetta, AstraZeneca), liraglutide (Saxenda, Novo Nordisk), albiglutide (Tanzeum, GlaxoSmithKline), dulaglutide (Trulicity, Eli Lilly) and lixisenatide (Adlyxin, Sanofi) – have been linked to adverse GI events such as abdominal pain, constipation, diarrhea, nausea and vomiting.
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However, anecdotal evidence has also indicated a possible risk for delayed gastric emptying with these medications, which could heighten risk for regurgitation and pulmonary aspiration during sedation.
In a multi-society statement, the GI societies wrote that there is “little or no data” related to the relative risk for complications from aspiration and the impact of stopping these therapies prior to upper gastrointestinal endoscopy or other moderate to deep sedated procedures is “unknown at this time.”
“As clinical gastroenterologists and hepatologists, we are very familiar with safety issues regarding the performance of endoscopy in our patients suffering from gastroparesis, as well as unexplained nausea, vomiting and epigastric pain, particularly in emergency situations,” the GI societies wrote. “As 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 these patients on GLP-1 receptor agonists.”
In the statement, the GI societies also called for further research and collaboration between GIs and their anesthesiology, endocrinology and industry partners to determine appropriate medication adjustments prior to elective endoscopy.
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