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Glucagon-Like Peptide-1 Receptor Agonists and Peri-Procedural Aspiration Risk.
Cindy N Ho1, Alessandra T Ayers1, Michael A Kohn2
1Diabetes Technology Society, Burlingame, CA 94010, USA.
Journal of the Endocrine Society
|September 2, 2025
Summary
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) do not appear to increase aspiration risk during surgery or endoscopy. Recent studies show no consistent link between GLP-1RA use and aspiration pneumonia, supporting continued use before procedures.
Area of Science:
- Anesthesiology
- Gastroenterology
- Pharmacology
Background:
- Delayed gastric emptying from GLP-1RAs raised concerns about aspiration risk during procedures.
- The American Society of Anesthesiologists (ASA) initially recommended discontinuing GLP-1RAs before surgery but later reversed this advice.
- This review examines evidence supporting or refuting the initial ASA recommendation.
Purpose of the Study:
- To systematically review evidence on the association between GLP-1RA use and aspiration risk.
- To evaluate the safety of continuing GLP-1RA use before elective surgical and endoscopic procedures.
Main Methods:
- Systematic review of retrospective cohort studies.
- Searched PubMed for studies published between June 2023 and March 2025.
- Calculated summary risk ratios for aspiration/pneumonia in GLP-1RA users versus non-users.
Main Results:
- Three studies on elective surgery showed a combined risk ratio of 1.00 [0.76, 1.30].
- Four studies on endoscopic procedures showed a combined risk ratio of 1.10 [0.95, 1.27].
- A parallel analysis confirmed the methodology could detect increased risk from opioid use (RR 2.68 [1.89, 3.81]).
Conclusions:
- Despite causing delayed gastric emptying, GLP-1RAs have not been consistently linked to increased aspiration risk.
- Real-world evidence does not support a significant GLP-1RA-associated aspiration risk for surgical or endoscopic procedures.
- Most patients can likely continue GLP-1RA therapy before elective procedures.
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