Impact of GLP-1 Analogue Therapy on Gastrointestinal Outcomes in Patients with Irritable Bowel Syndrome: A Real-World TriNetX Analysis.
Emergingsuggested applicable standard· American Society of Anesthesiologists, 'Practice Advisory for the Perioperative Management of Patients with Diabetes Mellitus Including Those Taking GLP-1 Receptor Agonists,' 2023
Decision at stakewhether a history of irritable bowel syndrome should be treated as a perioperative risk factor that influences GLP-1 management decisions
Perioperative management of a patient already taking a GLP-1 receptor agonist should be individualized through shared decision-making among the patient, the prescribing team, the proceduralist/surgeon, and the anesthesiologist, balancing metabolic need against aspiration risk from delayed gastric emptying. …
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
Perioperative management of a patient already taking a GLP-1 receptor agonist should be individualized through shared decision-making among the patient, the prescribing team, the proceduralist/surgeon, and the anesthesiologist, balancing metabolic need against aspiration risk from delayed gastric emptying. In patients WITHOUT known risk factors for delayed gastric emptying (e.g., pre-existing gastroparesis, diabetes mellitus with neuropathy, prior gastric surgery, or severe GERD), GLP-1RA therapy may be continued preoperatively. When holding is elected, hold the day-of-procedure dose for daily formulations and the dose one week before the procedure for weekly formulations, while acknowledging the guidance states the optimal hold duration is unknown. Regardless of hold status, assess every patient on the day of the procedure for symptoms of delayed gastric emptying (nausea, vomiting, abdominal pain, dyspepsia, distension); if present, manage the patient as a 'full stomach.' For patients WITH known risk factors for delayed gastric emptying, risk-mitigation options include a preoperative clear-liquid diet for at least 24 hours (as in colonoscopy/bariatric prep), point-of-care gastric ultrasound to assess residual gastric contents (limited by resources, inter-user variability, and credentialing), and consideration of rapid-sequence induction versus procedure deferral. The guidance explicitly cautions against reflexively withholding GLP-1RAs only in patients treated for overweight/obesity, which could constitute weight bias. The document does not address whether a GI condition warrants pre-initiation 'GI clearance' before starting a GLP-1RA; that question is not covered by this or any GI society guideline.