GLP-1 Drugs Do Not Increase Respiratory Complications After Endoscopy in Large Japanese Study | Research

The takeaway

GLP-1 RA use was not associated with increased post-EGD respiratory complications (0.39% vs 0.50%, OR 0.79, p=0.41) in 17,814 matched Japanese diabetic patients, supporting selective continuation.

No increased risk
GLP-1 drug users had numerically LOWER respiratory complication rates after endoscopy (0.39% vs 0.50%), supporting continuation for most patients

What the researchers found

GLP-1 RA vs non-use: respiratory complications 0.39% vs 0.50% (OR 0.79, p=0.41); severe respiratory 0.11% vs 0.077% (OR 1.45, p=0.52). Trends in new users (OR 1.43, NS) and severe diabetes (OR 1.28, NS).

Why it matters

Millions of GLP-1 drug users need endoscopies. Evidence that routine discontinuation is unnecessary for most patients reduces disruption to diabetes management.

How the study worked

Nationwide retrospective Japanese cohort (JMDC database), 1:4 propensity matching (3,568 GLP-1 RA vs 14,246 non-users), respiratory/severe complications within 14 days post-EGD.

What this study cannot tell us

Retrospective. Japanese population only. Cannot capture complications not coded. 14-day window may miss late events.

How to read the evidence

Large propensity-matched retrospective study. Adequate power to detect clinically meaningful differences.

When this study was published

Published in 2025.

The bigger picture

This supports the emerging consensus that GLP-1 drugs don't need routine discontinuation before GI procedures for most stable patients.

Questions still open

Should new GLP-1 users be treated differently than long-term users?
Does the finding apply to longer procedures like colonoscopy?
Would fasting protocols differ for GLP-1 users?

Common questions

Should I stop my GLP-1 drug before an endoscopy?

This large study found no increased respiratory risk from continuing GLP-1 drugs before endoscopy. Most stable, long-term users can safely continue. Discuss with your gastroenterologist.

Is there anyone who should stop GLP-1 before endoscopy?

New users and those with severe diabetes showed non-significant trends toward slightly higher risk. A cautious, individualized approach is reasonable for these subgroups.

Read the original research

Glucagon-like peptide-1 receptor agonist and respiratory complications after endoscopy: A Japanese nationwide cohort study.

Diabetes, obesity & metabolism, 28(1), 316-323

View on PubMed ↗Publisher’s paper ↗

Citation

Hisada, Hiroyuki; Ikeuchi, Kazuhiko; Tsuji, Yosuke; Yamamichi, Nobutake; Kakushima, Naomi; Okushin, Kazuya; Yakabi, Seiichi; Takeuchi, Chihiro; Ohki, Daisuke; Mizutani, Hiroya; Miura, Yuko; Kubota, Dai; Tsutsumi, Takeya; Fujishiro, Mitsuhiro. (2026). Glucagon-like peptide-1 receptor agonist and respiratory complications after endoscopy: A Japanese nationwide cohort study.. Diabetes, obesity & metabolism, 28(1), 316-323. https://doi.org/10.1111/dom.70194