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Guidance timeline

How ASA, AGA, ASMBS, ISPCOP, and SAGES positions on perioperative GLP-1 agonists evolved from a blanket hold to an individualized approach. Axis spacing reflects actual time between publications.

June 2023

Hold

ASA Consensus-Based Guidance on Preoperative Management of Patients on GLP-1 Receptor Agonists

ASA

First major US statement on the problem. Advised holding GLP-1 receptor agonists before elective procedures — daily agents on the day of surgery, weekly agents one week prior — regardless of indication or dose.

American Society of Anesthesiologists (society statement)

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November 2023 (online), 2024 in print

Individualize

AGA Rapid Clinical Practice Update on Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy

AGA

First pushback on blanket holding. Found insufficient evidence to justify routinely stopping therapy before endoscopy and recommended proceeding with standard fasting in patients without symptoms of delayed gastric emptying.

Clinical Gastroenterology and Hepatology

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October 2024

Individualize

Multisociety Clinical Practice Guidance for the Safe Use of GLP-1 Receptor Agonists in the Perioperative Period

AGAASMBSISPCOPSAGES

Consolidated four societies behind an individualized, risk-stratified approach: continue therapy in most patients, use a 24-hour clear liquid diet before the procedure, and reserve holding or further assessment for patients with symptoms or other aspiration risk factors.

Surgery for Obesity and Related Diseases

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November 2024

Individualize

Preprocedure Care of Patients on GLP-1 Receptor Agonists: A Multisociety Clinical Practice Guidance

ASAAGAASMBSISPCOPSAGES

ASA affirmed the multisociety guidance and published it in Anesthesiology, superseding its 2023 hold-everything position in practice and aligning anesthesia, gastroenterology, and bariatric surgery on individualized management.

Anesthesiology

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June 2023
Hold
ASA Consensus-Based Guidance on Preoperative Management of Patients on GLP-1 Receptor Agonists
ASA
First major US statement on the problem. Advised holding GLP-1 receptor agonists before elective procedures — daily agents on the day of surgery, weekly agents one week prior — regardless of indication or dose.
American Society of Anesthesiologists (society statement)
View source
November 2023 (online), 2024 in print
Individualize
AGA Rapid Clinical Practice Update on Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy
AGA
First pushback on blanket holding. Found insufficient evidence to justify routinely stopping therapy before endoscopy and recommended proceeding with standard fasting in patients without symptoms of delayed gastric emptying.
Clinical Gastroenterology and Hepatology
View source
October 2024
Individualize
Multisociety Clinical Practice Guidance for the Safe Use of GLP-1 Receptor Agonists in the Perioperative Period
AGAASMBSISPCOPSAGES
Consolidated four societies behind an individualized, risk-stratified approach: continue therapy in most patients, use a 24-hour clear liquid diet before the procedure, and reserve holding or further assessment for patients with symptoms or other aspiration risk factors.
Surgery for Obesity and Related Diseases
View source
November 2024
Individualize
Preprocedure Care of Patients on GLP-1 Receptor Agonists: A Multisociety Clinical Practice Guidance
ASAAGAASMBSISPCOPSAGES
ASA affirmed the multisociety guidance and published it in Anesthesiology, superseding its 2023 hold-everything position in practice and aligning anesthesia, gastroenterology, and bariatric surgery on individualized management.
Anesthesiology
View source

Educational reference only, not medical advice and is not affiliated with or endorsed by the organizations listed. Verify against primary sources and institutional protocol before applying to patient care.