VIDEO: Specialties, guidelines still dueling over ‘dilemma of GLP-1 agonists’ in endoscopy
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In a Healio video exclusive, Edward V. Loftus Jr., MD, noted that the booming popularity in glucagon-like peptide-1 agonists have spurred an interspecialty “dilemma” regarding aspiration risks in the endoscopy suite.
“The [American Society of Anesthesiologists] came out with a guideline that these need to be held for at least a day or a week, depending on the half-life of the drug, due to concerns for aspiration,” Loftus, the Maxine and Jack Zarrow Family Professor of Gastroenterology at the Mayo Clinic and chief medical editor of Healio Gastroenterology, said. “On the other hand, the GI societies have been coming out with statements that this guideline is based on very little data in fact, some data suggests that if there is a risk for aspiration, it is actually pretty low.”
In this month’s issue of Healio Gastroenterology, anesthesiologists clash with the gastroenterologists performing endoscopic procedures, who maintain that there is sparse available evidence to back claims of potential complications and that this overly conservative measure will only disrupt patient care.
Additionally, physicians have voiced concerns for compounding costs and clinical risks for patients who are now required to undergo general anesthesia for a procedure typically performed under only moderate sedation. However, because anesthesiologists play such a vital role in endoscopy procedures, surgeons and endoscopists are willing to acquiesce to the ASA’s recommendations until more high-level evidence becomes available.
“As a breakthrough treatment for common cardiometabolic syndromes, GLP1-RA use will continue to rise,” Walter W. Chan, MD, MPH, AGAF, FACG, wrote in an accompanying editorial. “It is imperative to establish a rational approach to preprocedural GLP-1RA management based on high-quality evidence.”
Chan added: “The approach suggested by AGA appears to be most sensible for the majority of patients, focusing on prolonged liquid-only diet coupled with standard fasting prior to procedures. Importantly, a collaborative, multidisciplinary approach with the anesthesiology team remains paramount in caring for these patients. More data is also vitally needed to address knowledge gaps, including the impact and risks of different subgroups based on GLP-1RA formulations, duration of therapy and comorbidities.”
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