Interested to know whether the OCULUS RCT is changing your opinion. Before this was published I'd assumed that holding a GLP-1 for one half life was useless; this study suggests otherwise.
It warrants further study with a larger group of patients outside of the endoscopy suite to replicate the results. If you look at this post covering a study using gastric ultrasound to examine preop surgery patients, nearly 50% of the patients had increased residual gastric contents despite holding one dose of semaglutide. What are we to make of the contradicting results? I wouldn't want to be too reassured by the findings of this one trial even though it makes me quite curious.
To me, the most important result from OCULUS was their finding that none of the patients in the EGD + colonoscopy group had residual gastric contents. This further supports that we can get these patients to have empty stomachs if they are fasted from solids for a prolonged period of time (24 hours in this study as well as at least one other study).
Nice summary of a topic that’s still evolving but definitely highly relevant for clinical practice. The indications for GLP1 agonists seem to be increasing by the day. I do feel, however, gastric ultrasound deserves a mention here. What are your thoughts on if it fits in the preoperative workflow?
Gastric ultrasound is probably the only effective way to risk stratify these patients on the day of surgery if they're following regular fasting guidelines. If imaging shows an empty stomach then you probably have no increased risk of aspiration.
Right now, I think it would be an ineffective widespread recommendation because most practices and providers are probably not able to perform it. Since 2024 it is being tested on the US oral boards, so I imagine there will be widespread adoption within the next 10 years. That could be practice changing across many situations (any urgent/emergent case), not just GLP-1 RA use.
Interested to know whether the OCULUS RCT is changing your opinion. Before this was published I'd assumed that holding a GLP-1 for one half life was useless; this study suggests otherwise.
It warrants further study with a larger group of patients outside of the endoscopy suite to replicate the results. If you look at this post covering a study using gastric ultrasound to examine preop surgery patients, nearly 50% of the patients had increased residual gastric contents despite holding one dose of semaglutide. What are we to make of the contradicting results? I wouldn't want to be too reassured by the findings of this one trial even though it makes me quite curious.
https://www.anesthesiathoughts.com/p/can-semaglutide-dosing-characteristics
To me, the most important result from OCULUS was their finding that none of the patients in the EGD + colonoscopy group had residual gastric contents. This further supports that we can get these patients to have empty stomachs if they are fasted from solids for a prolonged period of time (24 hours in this study as well as at least one other study).
Nice summary of a topic that’s still evolving but definitely highly relevant for clinical practice. The indications for GLP1 agonists seem to be increasing by the day. I do feel, however, gastric ultrasound deserves a mention here. What are your thoughts on if it fits in the preoperative workflow?
Gastric ultrasound is probably the only effective way to risk stratify these patients on the day of surgery if they're following regular fasting guidelines. If imaging shows an empty stomach then you probably have no increased risk of aspiration.
Right now, I think it would be an ineffective widespread recommendation because most practices and providers are probably not able to perform it. Since 2024 it is being tested on the US oral boards, so I imagine there will be widespread adoption within the next 10 years. That could be practice changing across many situations (any urgent/emergent case), not just GLP-1 RA use.