Doctors may not need to require patients discontinue GLP-1 agonists such as Wegovy and Ozempic for seven days before any surgery or endoscopy, according to a Houston Methodist Hospital-led study.

The study, published in the American Journal of Gastroenterology in June, found no substantial evidence to recommend significantly delaying procedures based on gastric emptying tests. Such delays are the current standard of practice.

Over the past five years, glucagon-like peptide-1 GLP-1 receptor agonists have surged in popularity, primarily for their efficacy in weight loss and diabetes management. These injectable medications enhance a gut hormone that signals fullness, thereby aiding weight loss. But they also slightly delay gastric emptying.

"The delay in gastric emptying has created concerns about managing patients on these medications during surgeries and endoscopies," said Dr. Thomas R. McCarty, a gastroenterologist and researcher at Houston Methodist who led the study. "Food could potentially remain in the stomach longer, increasing the risk of aspiration and pneumonia if it enters the windpipe during procedures."

In response to these concerns, the American Society of Anesthesiologists recommended that patients discontinue GLP-1 agonists at least seven days before any surgery or endoscopy. This precaution aims to minimize the risk of aspiration and related complications.

However, Dr. McCarty noted that this recommendation was not based on empirical data.

"While the ASA's guidelines prioritize patient safety, the lack of robust data made it important to objectively assess the impact of these drugs on gastric emptying," Dr. McCarty said.

Dr. McCarty's study involved a meta-analysis of 36 randomized controlled trials, assessing the effect of GLP-1 agonists on gastric emptying for over 1,500 patients. The results showed that these medications do delay gastric emptying of solid foods but only by about 36 minutes. The delay is relatively minor given the standard pre-procedure fasting period of six hours.

"For liquids, which are relevant for patients undergoing colonoscopies and consuming liquid prep, there was no significant delay in gastric emptying," Dr. McCarty added. "This finding suggests that the standard fasting guidelines should suffice to mitigate any risks."

The study's findings challenge the current seven-day hold recommendation, particularly for patients using GLP-1 agonists for diabetes management.

"Holding these medications for a week can significantly impact blood glucose control in diabetic patients," Dr. McCarty emphasized. "It's crucial to balance the benefits of these medications with any potential risks."

Subsequent studies corroborate Dr. McCarty's findings, indicating a minimal increase in aspiration risk. One study, analyzing a large pharmacologic database, identified an aspiration risk of approximately three in 100,000 patients.

"The data indicate that the gastric emptying delay is not substantial enough to warrant a seven-day hold before procedures," Dr. McCarty said. "For patients needing these medications, especially those with diabetes, the current guidelines may need to be reevaluated."

The study highlights the need for evidence-based guidelines and interdisciplinary cooperation and has significant implications for clinical practice. At Houston Methodist, current practice still adheres to the seven-day hold recommendation, but Dr. McCarty hopes the new evidence will prompt a revision of the guidelines.

"Our goal is to collaborate with anesthesiologists and surgeons to develop a standardized approach based on robust data," Dr. McCarty concluded. "We aim to ensure patient safety without unnecessarily disrupting essential medication regimens."