GLP-1 agonists before endoscopy: separating fact from fiction

Purpose of review Glucagon-1 receptor agonists (GLP-1A) delay gastric emptying, which has raised concerns about heightened risk of increased residual gastric volume (RGV) despite appropriate fasting measures. RGV could increase risk of pulmonary aspiration during sedated procedures like upper endoscopy. The purpose of this review is to summarize literature on pathophysiology of delayed gastric emptying, and to highlight recent publications on risk of RGV and preventive strategies. Recent findings GLP-1A delay gastric emptying via vagally mediated pathways; with long-term use this delay in gastric emptying is attenuated. GLP-1A significantly increases risk of RGV. Holding a dose of GLP-1A or continuing the medication with 24 h of clear liquids beforehand are both effective strategies. There is a trend towards greater effectiveness with the latter approach. In experienced hands, point of care ultrasound (POCUS) is highly accurate at identifying RGV before sedation. Summary Recent studies have considerably enhanced our understanding of the pathophysiology and risk of RGV with GLP1A.