在内镜手术之前,是否需要停止使用类似葡萄糖-1受体激动剂? 一个回顾性研究研究
Haider Ghazanfar1, Nismat Javed2, Abeer Qasim2
1Division of Gastroenterology, Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, United States.
World journal of gastroenterology
|August 1, 2024
概括
葡萄糖样-1受体激活剂 (GLP-1RA) 的使用在糖尿病和肥胖症中越来越多. 在内镜检查前24小时的液体饮食似乎是安全的,剩余食物最小,没有吸入风险. 建议对个性化患者管理进行进一步的研究.
科学领域:
- 胃肠病学 胃肠病学
- 内分泌学 在内分泌学.
- 临床研究 临床研究
背景情况:
- 类似葡萄糖-1受体激动剂 (GLP-1RA) 广泛用于治疗糖尿病和肥胖症.
- GLP-1RA可以引起胃衰竭,导致人们在内镜手术期间担心肺吸收.
- 目前的指导方针建议在手术前停止使用GLP-1RA,以减轻吸收风险.
研究的目的:
- 调查GLP-1RA在内镜手术期间对胃残留物质的影响.
- 评估GLP-1RA患者在术前饮食修改的安全性和有效性.
主要方法:
- 在BronxCare健康系统从2019年1月到2023年10月进行了回顾性图表审查.
- 在接受内镜检查的患者中,评估了胃残留物和吸收发生情况,比较清洁液体/低残留物饮食与常规饮食.
- 统计分析包括皮尔森的千平方和t测试,以确定显著的关联 (P <0.05).
主要成果:
- 在306名患者中,41.2%的人采用透明液体饮食,58.8%的人采用常规饮食.
- 清洁液体饮食的患者与常规饮食 (10%) (P = 0.03) 的患者相比,剩余食物显著减少 (1.5%).
- 在手术期间或之后,没有报告与吸入或残留食物相关的并发症.
结论:
- 24小时清洁液体饮食对于接受内镜手术的GLP-1RA患者来说是一个安全的策略,有效地减少剩余的胃含量.
- 虽然患有先前存在的胃肠道症状的患者可能会呈现较高残留食物风险的趋势,但这在统计学上并不显著.
- 需要进一步的研究来完善管理策略,考虑糖尿病持续时间,胃衰竭严重程度和GLP-1RA剂量等因素,以优化患者护理并最大限度地减少治疗中断.
相关概念视频
Glucagon-like Receptor Agonists
312
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
312
Hypoglycemia and Glucagon
229
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
229
Endoscopic Procedures V: ERCP
153
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
Patient...
153
Oral Hypoglycemic Agents: Glinides
150
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
150
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
168
α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
Acarbose and miglitol are...
168
Endoscopic Procedures I: Esophagogastroduodenoscopy
81
An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
During an EGD, the endoscope can be used to:
81


