| name | glp1-endoscopy-pre-procedure |
| description | 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. |
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
| Scenario | Recommended Action |
|---|
| Symptoms mild + elective procedure | Postpone — place patient on clear liquid diet 1 day before, reschedule |
| Symptoms present + urgent/semi-urgent procedure | Use RSI (Rapid Sequence Induction) with cricoid pressure; ensure airway-trained anaesthesiologist present |
| High suspicion of retained solid gastric content | Point-of-care ultrasound (USS) of stomach before proceeding |
| Gastroparesis confirmed or strongly suspected | Consider 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?
| Indication | Recommendation |
|---|
| Diabetes management | Do 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
