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

15B_Atkins_debate GLP1 Agonists Hold them or ignore them

Pdf Summary

The document by Joshua H. Atkins, MD, addresses the implications of using GLP-1 receptor agonists in the management of patients undergoing medical procedures, focusing on issues related to gastric emptying and potential aspiration risks. GLP-1 medications are noted to delay gastric emptying; however, this does not necessarily lead to increased aspiration risk. There are reported cases of aspiration in patients on GLP-1s, yet it's uncertain if these cases suggest an elevated risk or if they're biased observations.<br /><br />The discussion raises several questions, including how the choice and dosage frequency of these medications influence gastric emptying and how such effects compare to those in diabetic patients. The document also poses questions about the effects of GLP-1 medications, such as the phenomenon of tachyphylaxis and optimal medication withholding times.<br /><br />Several studies are referenced, investigating gastric content retention and the occurrence of pulmonary aspiration during endoscopic procedures in patients using GLP-1 receptor agonists, showing low incidence. The use of Point-of-Care Gastric Ultrasound (POCUS) emerges as a promising tool with high sensitivity and specificity for detecting "full stomachs," thus aiding in decision-making for patients on GLP-1s, especially in risky scenarios.<br /><br />Atkins suggests that for certain procedures like EGD, patients on GLP-1 medications can still proceed if they maintain a liquid diet 48 hours prior. He advises more conservative management for potentially high-risk patients in an aspiration event. Furthermore, Atkins advocates for comprehensive training in gastric ultrasound for relevant medical personnel and encourages international research collaborations to unify and strengthen procedural guidelines, as existing global recommendations vary.

Keywords

GLP-1 receptor agonists

gastric emptying

aspiration risks

tachyphylaxis

Point-of-Care Gastric Ultrasound

pulmonary aspiration

endoscopic procedures

liquid diet

gastric ultrasound training

international research collaborations