Glp1 Endoscopy Pre Procedure

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name: glp1-endoscopy-pre-procedure
description: Guide pre-endoscopy management decisions for patients on GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide etc.), deciding whether to proceed, delay, or modify the approach based on GI symptoms, fasting status, and indication. Trigger when a clinician asks about GLP-1 RA and endoscopy, semaglutide before colonoscopy, Ozempic before procedure, or whether to hold a GLP-1 agonist before endoscopy.
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# GLP-1 RA Pre-Endoscopy Decision Tool
### AGA 2024 Rapid Clinical Practice Update

When a patient on a GLP-1 receptor agonist (semaglutide, tirzepatide, liraglutide, dulaglutide, exenatide) is scheduled for endoscopy, work through these 5 steps.

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## Step 1 — Confirm the GLP-1 RA

Ask:
- Which agent and dose?
- Dosing frequency (daily vs weekly)?
- Indication: **diabetes management** OR **weight loss only**?

> Indication drives the hold decision in Step 5.

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## Step 2 — Screen for GI Symptoms

Ask about symptoms in the past 24–48 hours:
- Nausea / vomiting
- Dyspepsia or bloating
- Abdominal distension
- Early satiety or feeling of retained food

**No symptoms → go to Step 3.**
**Any symptoms → go to Step 4.**

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## Step 3 — Standard Fasting Met + No Symptoms → Proceed

Confirm:
- Solids: ≥ 8 hours fasted ✓
- Liquids: ≥ 2 hours fasted ✓
- No GI symptoms ✓

→ **Proceed with standard endoscopy.**
No additional modifications required.

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## Step 4 — Symptomatic Patient: Risk-Stratify and Modify

| Scenario | Recommended Action |
|---|---|
| Symptoms mild + elective procedure | **Postpone** — place patient on clear liquid diet 1 day before, reschedule |
| Symptoms present + urgent/semi-urgent procedure | Use **RSI (Rapid Sequence Induction)** with cricoid pressure; ensure airway-trained anaesthesiologist present |
| High suspicion of retained solid gastric content | **Point-of-care ultrasound (USS)** of stomach before proceeding |
| Gastroparesis confirmed or strongly suspected | Consider **G-POEM** or specialist GI referral before endoscopy |

> A **clear liquid diet the day before** is a practical middle-ground when the procedure cannot be postponed but symptoms are mild.

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## Step 5 — Should the GLP-1 RA Be Held?

| Indication | Recommendation |
|---|---|
| **Diabetes management** | **Do NOT hold** — stopping risks hyperglycaemia; proceed with standard precautions |
| **Weight loss only (no diabetes)** | **May consider holding** for 1 dosing interval (1 week for weekly agents, 1 day for daily agents) if symptomatic or elective |

> **Key principle:** The decision to proceed or postpone is driven by **symptoms and aspiration risk** — not by the drug alone. Do not reflexively cancel all endoscopies in patients on GLP-1 RAs.

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## Guardrails
- Do not cancel by default — lack of symptoms + adequate fasting = safe to proceed
- Never stop GLP-1 RA in a diabetic patient without endocrine/medical cover
- Symptoms > drug history — a symptomatic patient needs modification regardless of whether the drug was held
- This tool applies to **upper and lower GI endoscopy** (colonoscopy, EGD, EUS, ERCP)

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**Source:** Hashash JG, Thompson CC, Wang AY. AGA Rapid Clinical Practice Update on Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy. *Clin Gastroenterol Hepatol* 2024;22:705–707. DOI: [10.1016/j.cgh.2023.11.002](https://doi.org/10.1016/j.cgh.2023.11.002)