ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence (On-demand) | October 2024-15A_Rezaie Debate GLP1 Agonists Hold them or Ignore Them

15A_Rezaie Debate GLP1 Agonists Hold them or Ignore Them

Pdf Summary

GLP-1 receptor agonists (GLP-1 RAs) are medications primarily used to treat Type 2 Diabetes and support weight loss. They work by mimicking the GLP-1 hormone produced in the intestines, which delays gastric emptying and decreases appetite. GLP-1 RAs, unlike endogenous GLP-1, are resistant to DPP-4 degradation, giving them longer half-lives. Popular GLP-1 RAs include medications such as Ozempic, Rybelsus, and Wegovy, which show varying dosages and routes of administration such as subcutaneous or oral.<br /><br />Trends show increasing usage of GLP-1 RAs, particularly semaglutide, from 31% in 2019 to 88% in 2023 among new users, including those who do not have diabetes but are seeking weight loss interventions.<br /><br />Recent studies have raised concerns about the potential side effects of GLP-1 RAs, particularly related to gastrointestinal endoscopic procedures. These medications prolong gastric emptying, which can lead to food retention before endoscopies. This retention increases the risk of aspiration pneumonia due to a 33% higher aspiration rate attributed to GLP-1 RA usage compared to other diabetes medications like SGLT2 and DPP4 inhibitors, which do not affect gastric emptying.<br /><br />The implication of this slight absolute risk increase (0.2%) becomes significant given the volume of procedures—20 million gastrointestinal endoscopies annually in the U.S. If 3% of these patients are on GLP-1 RAs, this could lead to 1,200 additional cases of aspiration annually if preventive measures aren’t taken.<br /><br />Given these risks, holding GLP-1 RAs before elective endoscopies is recommended to minimize aspiration risk, as gastric retention might not be adequately mitigated by standard fasting protocols. This recommendation aligns with guidance from anesthesiology bodies to ensure patient safety.

Keywords

GLP-1 receptor agonists

Type 2 Diabetes

weight loss

gastric emptying

semaglutide

aspiration pneumonia

endoscopic procedures

Ozempic

Rybelsus

Wegovy