WATCH: Houston Methodist Experts Help Refine National Guidance on GLP-1 Medications and Surgery

Houston Methodist Hospital doctors are trying to help resolve the national debate over whether patients taking GLP-1 medications for diabetes or obesity should stop taking them before undergoing surgeries or procedures such as colonoscopies.

In a recent roundtable discussion, experts from the Houston Methodist Underwood Center for Digestive Health and MD Anderson Cancer Center discussed new evidence and an emerging consensus that supports a nuanced and individualized approach while avoiding unnecessary disruptions to patient care.

"For a time, patients were being asked to stop taking their GLP-1 medications for up to an entire week in advance of a procedure, despite minimal evidence of real risk," said Dr. Thomas McCarty, a gastroenterologist and endoscopy specialist at Houston Methodist. "But the latest randomized controlled data and updated guidelines now support a more personalized strategy."

The initial caution stemmed from concerns about delayed gastric emptying, a known side effect of GLP-1 receptor agonists such as semaglutide and tirzepatide. In rare cases, retained stomach contents could lead to aspiration under sedation or anesthesia. Early guidance from the American Society of Anesthesiologists recommended temporarily withholding the drugs, prompting widespread adherence across surgical specialties nationwide.

However, new multidisciplinary consensus guidelines developed with input from anesthesiology, gastroenterology and bariatric surgery societies suggest that, in most patients, continuation of GLP-1 medications is safe. The key recommendation is that patients without additional risk factors can remain on the medications as long as they adhere to a clear liquid diet for 24 hours before their procedure.

"The incidence of aspiration is extremely low: around 1 in 5,000 to 7,000 cases," said Dr. TJ Gan, an anesthesiologist at MD Anderson. "When we looked closely at the evidence, it became clear that risk is minimal in patients without preexisting gastric motility issues."

High-risk patients — such as those with diabetic gastroparesis, Parkinson's disease or a recent dose escalation — may still warrant individualized precautions, according to the expert panel. Likewise, patients on compounded GLP-1 formulations and patients undergoing point-of-care gastric ultrasounds should be monitored for increased risks.

Lifting the blanket recommendation to stop taking GLP-1 medications before surgery is a win for patients with obesity or type 2 diabetes, said Dr. Samaneh Dowlatshahi, an endocrinologist at Houston Methodist. "Stopping these medications can lead to spikes in blood glucose and weight gain, undermining months of progress."

The roundtable discussion emphasized Houston Methodist's collaborative, evidence-based leadership in aligning patient safety with optimal disease management. As the use of GLP-1s continues to expand into sleep apnea, addiction recovery and other areas of treatment, clinicians say ongoing multidisciplinary coordination will be essential.