目的:胰高血糖素样受体激动剂(GLP1-RAs)由于其可能延迟胃排空而引起围手术期的关注。美国麻醉医师协会建议在选择性内窥镜检查前暂停单剂量。然而,多个胃肠病学会随后的指令强调需要进一步评估以证实这种做法.我们的目的是评估连续使用GLP1-RA的内镜套管胃成形术(ESG)期间严重不良事件的发生频率和胃液残留。
方法:我们对2022年8月至2024年2月在三个中心接受GLP1-RA治疗的所有ESG患者进行了回顾性评估。根据标准协议,所有患者均至少24小时不吃固体食物,且在ESG之前12小时保持无口服.对患者特征、药物类型和剂量的记录进行审查。主要结果包括严重不良事件和根据患者记录保留的胃部产品,程序报告,和程序视频。
结果:连续57名成年人(89.5%的女性,平均年龄44±9岁,平均BMI为40.1±8.1kg/m2,T2DM为35.1%,有26.3%的T2DM患者)接受了ESG而不停止GLP1-RA,其中包括司马鲁肽(45.6%),利拉鲁肽(19.3%),杜拉鲁肽(22.8%),和替利平肽(12.3%)。插管时,内窥镜检查,和恢复,没有残留的胃固体,肺吸入,胃食管反流,或缺氧。
结论:对于具有天然胃解剖结构的成年人,≥24小时内镜检查前的纯液体饮食和≥12小时内镜检查前的快速饮食可能不需要常规上消化道内窥镜检查中断GLP1-RA。
OBJECTIVE: Glucagon-like receptor agonists (GLP1-RAs) have raised peri-procedural concerns due to their potential to delay gastric emptying. The American Association of Anesthesiologists has advised pausing a single dose before elective endoscopy. However, a subsequent directive from multiple gastroenterology societies underscored the need for further assessment to substantiate this practice. We aimed to evaluate the frequency of serious adverse events and retained gastric products during endoscopic sleeve gastroplasty (ESG) with uninterrupted GLP1-RA use.
METHODS: We conducted a retrospective evaluation of all patients undergoing ESG while on GLP1-RAs at three centers from August 2022 to February 2024. Per standard protocol, all patients had refrained from solid foods for at least 24 h and maintained nil per os for 12 h preceding their ESG. Records were reviewed for patient characteristics and medication type and doses. Primary outcomes included serious adverse events and retained gastric products based on patient records, procedure
reports, and procedural videos.
RESULTS: Fifty-seven consecutive adults (89.5% women, mean age of 44 ± 9 years, mean BMI of 40.1 ± 8.1 kg/m2, 35.1% with T2DM, and 26.3% with pre-T2DM) underwent ESG without stopping GLP1-RAs, which included semaglutide (45.6%), liraglutide (19.3%), dulaglutide (22.8%), and tirzepatide (12.3%). During intubation, endoscopy, and recovery, there were no instances of retained gastric solids, pulmonary aspiration, gastroesophageal regurgitation, or hypoxia.
CONCLUSIONS: A ≥ 24-h pre-endoscopy liquid-only diet with ≥ 12-h pre-endoscopy fast may negate the need for GLP1-RA interruption for routine upper endoscopy in adults with native gastric anatomy.