Aspiration Risk During Endoscopic Procedures While on GLP-1 Agonist Therapy

GLP-1 receptor agonists (GLP-1RAs) are increasingly prescribed for Type 2 diabetes and weight management. Given their effect on gastric emptying, concerns have emerged regarding aspiration risk during endoscopic procedures. While aspiration risk is recognized during esophagogastroduodenoscopy (EGD), data on GLP-1RA users-particularly those undergoing colonoscopy-are limited. This study evaluated aspiration risk in patients undergoing EGD versus colonoscopy while on GLP-1RA therapy.

We performed a retrospective cohort study of adult patients (18-70 years) who underwent EGD or colonoscopy at Baylor Scott & White Medical Center Temple from July 2017 to July 2024. Patients were stratified by GLP-1RA use. The primary outcome was aspiration-related diagnosis within 30 days, identified via ICD-10 codes. Chi-square testing and logistic regression were used to assess associations.

Among 13,523 patients (7431 EGD; 6092 colonoscopy), 713 (5.3%) were GLP-1RA users. Aspiration events were more frequent following EGD than colonoscopy (adjusted OR = 2.36, P = 0.0200). No aspiration events occurred in GLP-1RA users. Multivariable analysis identified Black race as independently associated with increased aspiration risk (adjusted OR = 2.77, P = 0.0061), while higher BMI was associated with lower aspiration risk. GLP-1RA users had higher BMI and more frequent diabetes and gastroparesis, but no independent association with aspiration risk was observed.

Aspiration risk was significantly higher with EGD than colonoscopy, but GLP-1RA use did not increase aspiration risk for either procedure. These findings suggest that routine GLP-1RA use may not be associated with increased aspiration risk in the outpatient setting. Prospective studies are needed to guide risk-based peri-procedural management.