Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study

BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1 RA)are effective in diabetes and obesity,reducing hyperglycemia by increasing insulin release and delaying gastric emptying.However,they can cause gastroparesis,raising concerns about aspiration during procedures.Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration.AIM To evaluate the effect of GLP-1 RAs on gastric residual contents during endosco-pic procedures.METHODS A retrospective chart review at BronxCare Health System,New York,from January 2019 to October 2023,assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures.Two groups were compared based on dietary status before the procedure.Data included demographics,symptoms of gastroparesis,opiate use,hemoglobin A1c,GLP-1 agonist indication,endo-scopic details,and aspiration occurrence.IBM SPSS was used for analysis,cal-culating means,standard deviations,and applying Pearson’s chi-square and t-tests for associations,with P<0.05 as being significant.RESULTS During the study,306 patients were included,with 41.2%on a clear liquid/low residue diet and 58.8%on a regular diet before endoscopy.Most patients(63.1%)were male,with a mean age of 60±12 years.The majority(85.6%)were on GLP-1 RAs for diabetes,and 10.1%reported digestive symptoms before endoscopy.Among those on a clear liquid diet,1.5%had residual food at endoscopy compared to 10%on a regular diet,which was statistically significant(P=0.03).Out of 31 patients with digestive symptoms,13%had residual food,all from the regular diet group(P=0.130).No complications were reported during or after the procedures.CONCLUSION The study reflects a significant rise in GLP-1 RA use for diabetes and obesity.A 24-hour liquid diet seems safe for endoscopic procedures without aspiration.Patients with upper gastrointestinal symptoms might have a higher residual food risk,though not statistically significant.Further research is needed to assess risks based on diabetes duration,gastroparesis,and GLP-1 RA dosing,aiming to minimize interruptions in therapy during procedures.

Ebola, the killer virus

Ebola virus disease(EVD)has mostly affected economically deprived countries as limited resources adversely affect a country’s infrastructure and administration.Probing into the factors that led to the widespread outbreak,setting forth plans to counter EVD cases in developing countries,and devising definitive measures to limit the spread of the disease are essential steps that must be immediately taken.In this review we summarize the pathogenesis of EVD and the factors that led to its spread.We also highlight interventions employed by certain countries that have successfully limited the epidemic,and add a few preventive measures after studying the current data.According to the available data,barriers to prevent and control the disease in affected countries include irresolute and disorganized health systems,substandard sanitary conditions,poor personal hygiene practices,and false beliefs and stigma related to EVD.The public health sector along with the respective chief authorities in developing countries must devise strategies,keeping the available resources in mind,to deal with the outbreak before it occurs.As a first step,communities should be educated on EVD’s symptoms,history,mode of transmission,and methods of protection,including the importance of personal hygiene practices,via seminars,newspapers,and other social media.A popular opinion leader(POL)giving this information would further help to remove the misconception about the nature of the disease and indirectly improve the quality of life of affected patients and their families.