Updated review of GLP-1 receptor agonist effects on upper GI endoscopy highlights delayed gastric emptying concerns, fasting protocol adjustments, and aspiration risk management for patients on these drugs.
Aspiration riskGLP-1 drugs delay gastric emptying, requiring extended fasting before endoscopy to prevent aspiration during sedated procedures
What the researchers found
GLP-1 drugs significantly affect upper GI endoscopy by delaying gastric emptying, requiring extended fasting protocols and consideration of medication timing to reduce aspiration risk and improve exam quality.
Why it matters
Millions of people on GLP-1 drugs will need endoscopy at some point. Inadequate preparation due to delayed gastric emptying can lead to dangerous aspiration or poor exam quality requiring repeat procedures.
The numbers in context
Previous meta-analysis showed increased risk of gastric residual content and aborted EGDs. This update includes additional studies and data on aspiration risk.
How the study worked
Updated review of evidence on GLP-1 RA effects on gastric emptying, endoscopy preparation, aspiration risk, and procedural outcomes.
Who was studied
Patients on GLP-1 receptor agonists undergoing upper gastrointestinal endoscopy
What this study cannot tell us
Review of available evidence with some recommendations based on expert opinion. Optimal fasting duration for GLP-1 users is not standardized across guidelines.
How to read the evidence
Moderate evidence: updated review with practical guidance, though some recommendations rely on expert opinion pending standardized guidelines.
When this study was published
Published in 2025. Timely update as GLP-1 prescribing creates new challenges for procedural medicine.
The bigger picture
As GLP-1 prescribing explodes, their effects on medical procedures across specialties are becoming increasingly important. Endoscopy preparation is just one example — similar concerns apply to any procedure requiring an empty stomach, including surgery under general anesthesia.
Questions still open
- What is the optimal fasting duration before endoscopy for patients on GLP-1 drugs?
- Should GLP-1 drugs be stopped before endoscopy and if so, how far in advance?
- Do different GLP-1 drugs affect gastric emptying to different degrees?
Common questions
Do I need to stop my GLP-1 drug before endoscopy?
Can GLP-1 drugs affect my endoscopy results?
Read the original research
Impact of GLP-1 receptor agonists on upper gastrointestinal endoscopy: an updated systematic review and meta-analysis.
Surgical endoscopy, 39(8), 5135-5151
Citation
Abdulraheem, Ahmad; Abujaber, Bara; Ayers, Lindsay; Al-Zureikat, Qusai; Bashiri, Kiandokht; Almhanni, Ghaith; Altork, Nadera; Afzal, Usman; Qarkash, Dania; Spyros, Peppas; Cho, Won K. (2025). Impact of GLP-1 receptor agonists on upper gastrointestinal endoscopy: an updated systematic review and meta-analysis.. Surgical endoscopy, 39(8), 5135-5151. https://doi.org/10.1007/s00464-025-11962-4