Gastric Ultrasound Assessment for Patients Taking GLP1 Agonists
Study Details
Study Description
Brief Summary
The aim of this study is to perform bedside gastric point of care ultrasound (POCUS) exams to assess the gastric volume and content (clear liquids vs solid food) perioperatively in patients who take glucagon-like peptide 1 (GLP-1) agonist medications compared to patients who do not take GLP-1 agonists.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Glucagon-like peptide 1 (GLP-1) agonists have existed since 2005, however the newer once-weekly injectable medications particularly semaglutide, and tirzepatide have exploded in popularity due to their weight loss potential.
Anesthesiologists nationally have seen an increase in perioperative complications amongst patients taking these medications due to delayed gastric emptying increasing the risk of aspiration in the perioperative period. At HSS the majority of our anesthetics are done under sedation and therefore would not protect the patient from aspiration in the event of vomiting.
Protecting patients from aspiration secondary to vomiting during induction or maintenance of anesthesia has always been an important goal to make anesthesia safer leading to the development of NPO guidelines which are intended to protect against the presence of gastric content during anesthetic care. However there is growing concern that patients taking GLP-1 agonists may not be adequately protected using the current nothing by mouth or "NPO" guidelines. Up to this day there is no literature on how much gastric emptying is delayed during the use of GLP1 following the standard NPO guidelines.
Recently Gastric Ultrasound (GUS) has been introduced as a bedside tool for assessing a patients stomach contents and for the risk of aspiration. Gastric ultrasound can identify an empty stomach, a stomach filled with clear liquids, thick liquids or solid food content. If a stomach has clear liquid the volume can be calculated accurately. Generally a stomach with solid or thick liquid content or with clear liquid measuring more than 1.5 ml/kg body weight is considered a full stomach. As GUS is noninvasive and well tolerated, it offers the perfect solution to assessing patient risk in the preoperative period.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Control The control group will be comprised of patients who are not currently taking any GLP-1 agonist medications. Controls will receive the ultrasound exam to assess stomach contents. |
Other: Gastric Ultrasound Exam
A gastric ultrasound is a simple, fast, non-invasive bedside diagnostic test that provides a qualitative and quantitative assessment of gastric contents. There are no known risks of a gastric ultrasound exam.
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| GLP-1 agonist intake The GLP-1 agonist intake group will be comprised of patients who are currently taking any GLP-1 agonist medications. This group will receive the ultrasound exam to assess stomach contents. |
Other: Gastric Ultrasound Exam
A gastric ultrasound is a simple, fast, non-invasive bedside diagnostic test that provides a qualitative and quantitative assessment of gastric contents. There are no known risks of a gastric ultrasound exam.
|
Outcome Measures
Primary Outcome Measures
- incidence of delayed gastric emptying [This will be measured pre-operatively in the holding room area.]
delayed gastric emptying is defined by the presence of either solid food, thick liquids or a specific volume (>1.5 ml/kg) of clear liquids on gastric ultrasound.
Secondary Outcome Measures
- Nothing by mouth (NPO) intervals [This will be measured pre-operatively in the holding room area.]
Measure the NPO interval after last solid, liquids, and clears precisely for a subgroup analysis.
- Presence of gastric peristalsis [This will be measured pre-operatively in the holding room area.]
Gastric peristalsis will be graded as present/ absent on gastric ultrasound
Eligibility Criteria
Criteria
Inclusion Criteria:
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GLP 1 patient group: any patient on GLP1 agonists that are dosed once per week (semaglutide, dulaglutide, tirzepatide), for all indications.
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Control group (No GLP 1 patients): any patient not on GLP1 agonists that are dosed once per week, for all indications.
Exclusion Criteria:
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patient refusal to participate
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patients with gastric bypass or any other gastric surgery
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large hiatal hernia
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patients with large ascites
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patients on peritoneal dialysis
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emergency surgery
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pre-existing diagnosis of gastroparesis
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Hospital for Special Surgery, New York
Investigators
- Principal Investigator: Oliver Panzer, MD, Hospital for Special Surgery, Department of Anesthesiology
Study Documents (Full-Text)
None provided.More Information
Publications
- Maselli DB, Camilleri M. Effects of GLP-1 and Its Analogs on Gastric Physiology in Diabetes Mellitus and Obesity. Adv Exp Med Biol. 2021;1307:171-192. doi: 10.1007/5584_2020_496.
- Nakatani Y, Maeda M, Matsumura M, Shimizu R, Banba N, Aso Y, Yasu T, Harasawa H. Effect of GLP-1 receptor agonist on gastrointestinal tract motility and residue rates as evaluated by capsule endoscopy. Diabetes Metab. 2017 Oct;43(5):430-437. doi: 10.1016/j.diabet.2017.05.009. Epub 2017 Jun 23.
- Silveira SQ, da Silva LM, de Campos Vieira Abib A, de Moura DTH, de Moura EGH, Santos LB, Ho AM, Nersessian RSF, Lima FLM, Silva MV, Mizubuti GB. Relationship between perioperative semaglutide use and residual gastric content: A retrospective analysis of patients undergoing elective upper endoscopy. J Clin Anesth. 2023 Aug;87:111091. doi: 10.1016/j.jclinane.2023.111091. Epub 2023 Mar 2.
- 2023-0867