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glp1-endoscopy-pre-procedure

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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  • SKILL.md3.4 KB
  • README.md1.7 KB
  • system-prompt.md3.5 KB

SKILL.md(原文)

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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.


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.


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.


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.


Step 4 — Symptomatic Patient: Risk-Stratify and Modify

ScenarioRecommended Action
Symptoms mild + elective procedurePostpone — place patient on clear liquid diet 1 day before, reschedule
Symptoms present + urgent/semi-urgent procedureUse RSI (Rapid Sequence Induction) with cricoid pressure; ensure airway-trained anaesthesiologist present
High suspicion of retained solid gastric contentPoint-of-care ultrasound (USS) of stomach before proceeding
Gastroparesis confirmed or strongly suspectedConsider 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.


Step 5 — Should the GLP-1 RA Be Held?

IndicationRecommendation
Diabetes managementDo 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.


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)

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

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