In a study of 3,415 endoscopy patients, GLP-1 receptor agonist use accounted for only 2% of cases with retained stomach contents, while opioid use accounted for 35%, suggesting confounding factors drive most of the associated risk.
2% vs. 35%GLP-1 receptor agonists accounted for only 2% of retained stomach contents cases before endoscopy, compared to 35% for opioid use — suggesting GLP-1 drugs are a minor contributor to this safety concern.
What the researchers found
Out of 3,415 patients who underwent upper endoscopy over eight years, 129 (3.8%) had clinically significant delayed gastric emptying (CSDGE) with retained stomach contents.
GLP-1 receptor agonist use was associated with only 2% of CSDGE cases — the lowest frequency among all assessed factors. Opioid use accounted for 35% of cases, the highest contribution.
The odds ratio for CSDGE in GLP-1 RA users was 2.5, but the confidence interval was wide (95% CI: 0.75-8.29) and crossed 1.0, meaning the association was not statistically significant. Critically, every patient who had CSDGE while on a GLP-1 RA was simultaneously taking other medications or had conditions independently associated with delayed gastric emptying.
Why it matters
The recommendation to stop GLP-1 drugs before surgery or procedures has created anxiety for patients and logistical headaches for clinicians. If GLP-1 drugs are not the primary driver of retained stomach contents — and opioids and other factors are far more important — the current blanket recommendation may be overly cautious. This study supports a more nuanced, case-by-case approach that considers all risk factors rather than singling out GLP-1 drugs.
How the study worked
Single-center retrospective study spanning eight years. Researchers reviewed records of 3,415 asymptomatic patients who underwent esophagogastroduodenoscopy (EGD) with or without colonoscopy. They identified 129 patients with clinically significant delayed gastric emptying and assessed the contribution of various factors including GLP-1 RA use, opioid use, and other medications or conditions known to affect gastric emptying. The analysis controlled for common confounding factors that previous studies had largely ignored.
What this study cannot tell us
This is a single-center retrospective study, limiting generalizability. The sample of GLP-1 RA users with CSDGE was very small, resulting in a wide confidence interval that could not achieve statistical significance. The study could not determine whether GLP-1 RA contributed partially to CSDGE in patients with multiple risk factors — only that other factors were always present. Specific GLP-1 RA agents and doses were not differentiated. The eight-year timeframe likely includes periods when GLP-1 RA use was less common, potentially underrepresenting current usage patterns.
How to read the evidence
This is a retrospective single-center study with a small number of GLP-1 RA cases experiencing the outcome of interest. While the finding that confounding factors are always present is informative, the wide confidence interval and inability to isolate GLP-1 RA effects limit the strength of conclusions. Larger prospective studies with proper controls are needed.
When this study was published
Published in 2024, this study addresses a very current clinical debate about perioperative management of GLP-1 drugs. Guidelines in this area are actively evolving as more evidence accumulates.
The bigger picture
As tens of millions of people now take GLP-1 drugs for diabetes and obesity, the practical implications of pre-procedural guidance are enormous. If millions of patients must stop their GLP-1 medication a week before any procedure, this affects blood sugar control, weight management, and healthcare logistics. Understanding the actual magnitude of aspiration risk — and the role of confounding factors — is essential for developing evidence-based guidelines that balance safety with treatment continuity.
Questions still open
- Should pre-procedural GLP-1 RA guidelines be updated to focus on individual risk assessment rather than blanket drug discontinuation?
- Does the dose or type of GLP-1 RA (short-acting vs. long-acting) affect the magnitude of gastric emptying delay?
- Would a prospective study with gastric emptying measurements confirm that GLP-1 RA alone rarely causes clinically significant retained contents?
Common questions
Should I stop my GLP-1 medication before a medical procedure?
Why do GLP-1 drugs slow stomach emptying?
Read the original research
Confounding Factors in the Association Between Glucagon-Like Peptide-1 Receptor Agonist Use and Retained Gastric Contents in Asymptomatic Patients Undergoing Upper Gastrointestinal Endoscopy: A Retrospective Study.
Cureus, 16(9), e69152
Citation
Elimihele, Thomas A; Mangrola, Anjali M; Oshomoji, Oluwatobi; Wilson, Nateshia B; Nnamani, Ikenna; Ashong, Bryan; Billings, Sunteasja; Getu, Daniel K; Kumar, Sachin; Maliakkal, Benedict. (2024). Confounding Factors in the Association Between Glucagon-Like Peptide-1 Receptor Agonist Use and Retained Gastric Contents in Asymptomatic Patients Undergoing Upper Gastrointestinal Endoscopy: A Retrospective Study.. Cureus, 16(9), e69152. https://doi.org/10.7759/cureus.69152