Matthew Oh
Introduction
Glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/GIP agents are increasingly prescribed for obesity and type 2 diabetes. Concerns remain about a possible link with acute pancreatitis. This review summarises current evidence and assesses whether pancreatitis represents a clinically relevant adverse effect influencing peri-operative assessment, patient selection, and suitability for day-case surgery.
Methods
A narrative review was undertaken including observational studies, post-marketing surveillance data, regulatory safety communications, and systematic reviews. Evidence was drawn from pharmacovigilance databases, randomised controlled trial safety analyses, and real-world cohort studies evaluating pancreatic outcomes in patients receiving GLP-1 and dual GLP-1/GIP therapies.
Results
Early post-marketing reports and case series described acute pancreatitis in temporal association with GLP-1 therapy. Large randomised trials have not shown a significant increase in pancreatitis incidence but were not designed to detect rare events. Observational and pharmacovigilance data suggest a small but consistent signal, particularly in patients with risk factors including gallstone disease, hypertriglyceridaemia, or rapid weight loss. In the peri-operative setting, unrecognised pancreatitis may present with non-specific symptoms, contributing to late cancellations, diagnostic uncertainty, or unplanned admission after attempted day-case surgery. Proposed mechanisms include pancreatic ductal changes, increased exocrine activity, and gallbladder hypomotility.
Conclusions
The link between incretin-based therapies and pancreatitis remains uncertain but is increasingly recognised as a peri-operative concern. A cautious approach is advised, particularly in higher-risk patients. Pre-operative risk assessment, patient education on symptoms, and early investigation of suspected cases are recommended. Awareness may improve patient selection, reduce unplanned admissions, and support safe, efficient day-case surgical pathways.
Authors
Matthew Oh, Tamer Hasablla, Basim Al-Robaie, Shameen Jaunoo
East Sussex Healthcare NHS Trust, Hastings, United Kingdom