A large propensity-matched study of nearly 19,000 patients found that active GLP-1 receptor agonist use was not associated with increased pneumonia, hospitalization, or emergency visits after gastrointestinal endoscopy with sedation.
Pneumonia: 0.13% vs 0.25%GLP-1 drug users actually had lower (not higher) pneumonia rates after sedated endoscopy compared to non-users, though the difference was not statistically significant — directly contradicting safety concerns about aspiration risk.
What the researchers found
In a propensity-matched cohort of 3,825 GLP-1RA users and 14,920 controls undergoing gastrointestinal endoscopy (63% colonoscopy, 25% EGD, 12% bidirectional):
- Postprocedure pneumonia: 0.13% vs 0.25% (OR 0.56, 95% CI: 0.22-1.45) — no significant difference
- 30-day postprocedural hospitalization: 1.9% vs 2.6% (OR 0.76, 95% CI: 0.59-0.98) — GLP-1 users actually had lower rates
- No significant association with urgent care visits, emergency department visits, or 7- or 30-day mortality
Results were adjusted for sedation type (conscious sedation vs. monitored anesthesia care) and study year. The findings held across procedure types.
Why it matters
This study directly addresses one of the most debated safety questions in anesthesiology and gastroenterology: should GLP-1 drugs be stopped before procedures requiring sedation? Many anesthesia guidelines have recommended holding GLP-1 drugs before surgery and endoscopy due to aspiration risk from delayed gastric emptying. This large real-world study provides the strongest evidence to date that uninterrupted GLP-1 therapy does not increase adverse events after sedated endoscopy, which could change clinical practice and reduce unnecessary medication interruptions.
How the study worked
This was a propensity-matched retrospective cohort study using data from January 2008 to June 2023. Patients with active GLP-1RA prescriptions at the time of GI endoscopy were matched 1:4 to non-GLP-1RA-exposed controls using propensity scores generated by logistic regression. Primary outcomes were postprocedural pneumonia and all-cause hospitalization, further adjusted for sedation type and study year. Secondary outcomes included urgent care visits, emergency department visits, and 30-day mortality.
What this study cannot tell us
This is a retrospective observational study, which cannot definitively prove causation or exclude all confounders despite propensity matching. The study period (2008-2023) includes years when GLP-1 drug use was much less common, potentially affecting the representativeness of early patients. The specific GLP-1 drugs, doses, and duration of use before procedures were not differentiated. Gastric residual volumes were not measured, so the mechanism behind the safety findings is not established. The study focused on GI endoscopy specifically — results may not generalize to longer surgical procedures with deeper anesthesia.
How to read the evidence
This is a large, well-designed propensity-matched retrospective cohort study with nearly 19,000 patients and adjustment for key confounders including sedation type. While not a randomized trial, the sample size, matching methodology, and consistency across multiple outcomes make this moderate-high quality real-world evidence.
When this study was published
Published in 2026, this is a very current study addressing one of the most actively debated safety questions in perioperative medicine regarding GLP-1 drugs.
The bigger picture
The question of whether to hold GLP-1 drugs before procedures has become one of the most common clinical dilemmas as these medications are prescribed to tens of millions of patients. The American Society of Anesthesiologists has issued guidance recommending holding GLP-1 drugs before elective procedures, but this has been largely precautionary rather than evidence-based. This study provides substantial real-world evidence that may help refine those guidelines and avoid unnecessary treatment interruptions that can destabilize blood sugar control.
Questions still open
- Should anesthesia guidelines be updated to allow uninterrupted GLP-1 therapy before endoscopy based on these findings?
- Do these safety results extend to longer surgical procedures requiring general anesthesia with intubation?
- Does the timing of the last GLP-1 dose relative to the procedure affect aspiration risk, even if overall outcomes are reassuring?
Common questions
Do I need to stop my GLP-1 medication before a colonoscopy or endoscopy?
Why were people worried about GLP-1 drugs and sedation in the first place?
Read the original research
Glucagon-like Peptide-1 Receptor Agonists and Risk of Pneumonia and Postprocedure Hospitalization Among Patients Undergoing Gastrointestinal Endoscopy.
Gastro hep advances, 5(3), 100869
Citation
Qiu, Chunyuan; Chen, Qiaoling; Tovar, Stephanie; Kwok, Karl; Hernandez Conte, Antonio T; Ferrara, Jammie T; Desai, Vimal; Shi, Jiaxiao M; Giap, Andrew Q; Wu, Bechien U. (2026). Glucagon-like Peptide-1 Receptor Agonists and Risk of Pneumonia and Postprocedure Hospitalization Among Patients Undergoing Gastrointestinal Endoscopy.. Gastro hep advances, 5(3), 100869. https://doi.org/10.1016/j.gastha.2025.100869