GLP-1 Receptor Agonists and Endoscopy: Understanding Gastric Stasis, Aspiration Risk, and Contemporary...

Area of Science:

• Gastroenterology
• Endocrinology
• Pharmacology

Background:

• Rising obesity, type 2 diabetes mellitus (T2DM), and metabolic dysfunction-associated steatotic liver disease (MASLD) increase glucagon-like peptide-1 receptor agonist (GLP-1RA) use.
• GLP-1RAs offer metabolic, cardiovascular, and hepatic benefits but slow gastric emptying, raising concerns for endoscopy.
• Concerns include retained gastric contents (RGC), procedural issues, and aspiration risk during sedation.

Purpose of the Study:

• To review evidence on GLP-1RA effects on gastric motility and peri-endoscopic outcomes.
• To guide procedural decisions based on physiological and clinical data.
• To synthesize evidence on GLP-1RA therapy and gastrointestinal endoscopy risks.

Main Methods:

• Narrative synthesis of mechanistic, physiological, and clinical evidence.
• Inclusion of data from pharmacological studies, scintigraphy, observational cohorts, and consensus statements.
• Analysis of peri-endoscopic outcomes and aspiration rates in GLP-1RA users.

Main Results:

• GLP-1RA use is linked to increased RGC and procedural disruptions in upper endoscopy.
• No increased aspiration pneumonia observed with GLP-1RA use during colonoscopy (0.01%-0.05% rates).
• A small absolute rise (<0.3%) in aspiration events during upper endoscopy noted.

Conclusions:

• Current guidelines recommend continuing GLP-1RA therapy with risk assessment and modified preparation.
• Strategies include dietary changes, risk stratification, point-of-care ultrasound, and communication.
• Pre-procedural clear liquid diets and individualized timing may reduce RGC risk.