Most patients can safely continue to take glucagon-like peptide-1 (GLP-1) receptor agonists as prescribed before undergoing elective surgery and gastrointestinal endoscopies, according to new clinical guidelines published today by the five surgical and medical societies, including the American Society for Metabolism and Bariatric Surgery (ASMBS), American Society of Anesthesiologists (ASA), American Gastroenterological Association (AGA), International Society for Perioperative Care of the Obesity Patient (ISPCOP) and American Society of Gastrointestinal and Endoscopic Surgeons (SAGES).

The guide, published online in Surgery for obesity and related diseases (SOARD), Surgical endoscopyand Clinical Gastroenterology and Hepatology, warned anyway that patients at high risk of significant gastrointestinal adverse reactions should be on a liquid diet for 24 hours before a procedure and the anesthetic plan adjusted accordingly. In rare cases, the procedure must be postponed.

GLP-1, used to treat obesity, diabetes and heart problems, delays gastric emptying and residual food or fluid in the stomach at the time of surgery under general anesthesia can increase the risk of serious complications, including aspiration. On the other hand, withholding drugs so patients can have surgery can be even riskier, which is what the new guideline prompted. It is also important to note that the risk of delayed gastric emptying decreases over time for most patients taking these drugs.

Our goal is to raise awareness of a potential safety issue in order to prevent it, said Ann M. Rogers, MD, president, ASMBS, the largest society for metabolic and bariatric surgeons in the United States.

In most cases, patients can continue to take their medications, however, individual risk factors for complications should be assessed preoperatively before proceeding further.”

Ann M. Rogers, MD, President, ASMBS

The authors wrote, “the purpose of this clinical practice guideline is to provide unified, multi-society guidance for the safe management of patients requiring GLP-1RA therapy, regardless of indication, which currently includes type 2 diabetes, obesity and obesity and heart failure, during the periprocedural period”.

The full guide is published in DEAD, Clinical Gastroenterology and Hepatology and Surgical Endoscopy.