Before the scope: precision medicine in medication management for endoscopic safety and quality

INTRODUCTION: Medication management is central to endoscopic safety because comorbidities, polypharmacy, and variable drug responses can substantially influence procedural risk. This review examines how a precision medicine approach can improve peri-endoscopic decision-making and patient outcomes. AREAS COVERED: A structured literature review of PubMed/MEDLINE, Embase, and the Cochrane Library (2000-2025) evaluated evidence on medications and supplements affecting endoscopic safety and efficacy. The review examined drug classes influencing bleeding, sedation, bowel preparation, aspiration, metabolic stability, and diagnostic accuracy, with emphasis on individualized management strategies. EXPERT OPINION: Precision-based medication review should be embedded in routine endoscopy practice through multidisciplinary collaboration, structured reconciliation, and risk stratification. Wider adoption of pharmacogenomic-informed and individualized protocols may reduce preventable complications, improve diagnostic quality, and support safer, more patient-centered care.