From the Guidelines
Semaglutide can be used in patients who have undergone gastric bypass surgery, but with caution and close monitoring, as the most recent and highest quality study suggests its safety and efficacy in this population 1.
Key Considerations
- The medication should typically be started at a lower dose (such as 0.25 mg weekly for injectable semaglutide) and titrated more slowly than in non-bariatric surgery patients, with careful attention to tolerability.
- Patients who have had gastric bypass already experience changes in gut hormone signaling similar to those induced by GLP-1 receptor agonists like semaglutide, which may increase the risk of gastrointestinal side effects such as nausea, vomiting, and diarrhea.
- There are also theoretical concerns about increased risk of hypoglycemia when combining the metabolic effects of bariatric surgery with GLP-1 receptor agonists.
- The altered gastrointestinal anatomy following bypass surgery could potentially affect drug absorption, although semaglutide is administered subcutaneously or orally with specific formulation.
Monitoring and Education
- Patients should be educated about potential overlapping side effects and instructed to maintain adequate hydration and report severe gastrointestinal symptoms promptly.
- Regular follow-up appointments are essential to monitor weight loss, glycemic control, and potential adverse effects.
Recent Evidence
- A recent narrative review of clinical pharmacology and implications for peri-operative practice found that GLP-1 receptor agonists like semaglutide can be used in patients with obesity, including those who have undergone gastric bypass surgery 1.
- Another study found that semaglutide can result in substantially greater weight loss in patients without diabetes, with a mean weight loss of 14.9% in patients who were non-diabetic, overweight or obese 1.
- However, there is emerging evidence that GLP-1 receptor agonist use in the peri-operative period is associated with an increased risk of pulmonary aspiration under anaesthesia 1.
From the Research
Safety of Semaglutide in Gastric Bypass Patients
- Semaglutide, a glucagon-like peptide-1 receptor agonist, has been shown to be effective in treating postprandial hypoglycemia induced by Dumping Syndrome (DS) after bariatric surgery 2.
- However, there are concerns about the safety of semaglutide in patients who have undergone gastric bypass surgery, particularly with regards to delayed gastric emptying and pulmonary aspiration 3, 4, 5, 6.
- Studies have reported cases of regurgitation and pulmonary aspiration of gastric contents in patients taking semaglutide, despite compliance with preoperative fasting guidelines 3, 4, 5, 6.
- Anesthesiologists should be aware of the potential risks of semaglutide and take precautions to mitigate them, such as holding the medication four weeks prior to a scheduled procedure or using full stomach precautions 3, 4, 5, 6.
Considerations for Anesthesia
- Patients taking semaglutide may have a full stomach despite compliance with routine pre-operative fasting guidelines, increasing the risk of pulmonary aspiration 3, 4, 5, 6.
- Gastric ultrasound may be useful in the pre-operative environment to help identify patients at high risk of aspiration 4.
- Rapid sequence induction and tracheal intubation can be used as precautions to prevent pulmonary aspiration of gastric contents 4.
Efficacy of Semaglutide in Gastric Bypass Patients
- Semaglutide has been shown to be effective in reducing episodes of reactive hypoglycemia and improving the quality of life in patients with postprandial hypoglycemia induced by Dumping Syndrome (DS) after bariatric surgery 2.
- The effect of semaglutide on reducing hypoglycemic episodes was persistent for up to 8 months in one study 2.