Endoscopy & GLP-1 Receptor Agonists

aspiration endoscopy glp-1 ra ozempic rapid sequence induction Oct 28, 2024

🌊 The new wave of aspiration risk is here. The rapid increase in popularity of GLP-1 receptor agonists (GLP1-RA) has brought new dilemmas in airway management to the endoscopy unit. Ozempic, Wegovey, and Saxenda are just some of the TGA-approved formulations in Australia.

🧠 GLP-1 RA significantly delay gastric emptying, primarily through smooth muscle relaxation in the distal stomach. The result is a dangerous and unpredictable retention of solids in the stomach, sometimes after as long as 30 hours of fasting.

🔺 So what does the anaesthetic team need to know?

Firstly, the guidance on this topic is based on expert consensus and is likely to evolve in the coming years. At the time of writing (October 2024), the primary recommendation comes from ANZCA’s Clinical Practice Recommendation On Periprocedural Use Of GLP-1/GIP Receptor Agonists. This recommendation was developed following 6 cases of non-fatal aspiration in “fasted” patients taking GLP-1 RAs, and is aimed at reducing the risk of the much-feared pulmonary aspiration seen in unfasted patients with an unprotected airway.

Key steps to reducing risk:

1️⃣ Ask EVERY patient if they are taking a GLP-1 RA.  

2️⃣ There is no evidence to support the omission of GLP-RAs prior to endoscopy.  

3️⃣ Patients who have taken a GLP-1 in the 4 weeks leading up to endoscopy should follow a fluid-only diet for 24 hours prior to their procedure.  

4️⃣ Routine bowel preparation is recommended in patients booked for colonoscopy.  

5️⃣ If there are clinical concerns about aspiration risk, consider a “minimally invasive” gastroscopy to inspect the stomach. The procedure should be abandoned if gastric contents are evident.  

6️⃣ If gastric contents are present, deep sedation for either gastroscopy or colonoscopy should be reconsidered. There should ALWAYS be equipment and trained staff for immediate rapid sequence induction during these procedures.  

7️⃣ IV erythromycin and the presence of an anaesthetist should be considered in urgent cases where aspiration risk is a concern.

💭 These recommendations do not replace clinical judgement and are due for review in December of 2024.

✅ Build knowledge  

✅ Improve safety 

References:

Madden, Jack D. FANZCA and Goyen, Andrew K. (2024) "The new era of aspiration risk: The dilemma of GLP-1 receptor agonists," Journal of Perioperative Nursing: Vol. 37 : Iss. 1 , Article 5. Available at: https://doi.org/10.26550/2209-1092.1291

Australian Diabetes Society, National Association of Clinical Obesity Services, Gastroenterological Society of Australia, and Australian and New Zealand College of Anaesthetists. Clinical Practice Recommendation on Periprocedural Use of GLP-1/GIP Receptor Agonists. Consensus Clinical Guide, June 2024. Available at https://www.anzca.edu.au/news/glp-1-gip-receptor-agonists-clinical-practice-guid.



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