GLP-1 drugs increase retained gastric content 6-fold before endoscopy but do not significantly increase aspiration risk | Research

The takeaway

Meta-analysis of 12 studies (105,515 patients) shows GLP-1 drugs increase retained gastric content 6.3-fold (OR 6.30), aborted procedures 5.5-fold (OR 5.50), but do NOT significantly increase aspiration risk (OR 1.26, NS), with clear liquid diet potentially mitigating RGC.

No aspiration risk increase
Despite 6x more retained gastric content, GLP-1 drugs did NOT significantly increase aspiration risk during endoscopy—manageable with clear liquid preparation

What the researchers found

RGC: OR 6.30 (5.30-7.49, I²=0%). Aborted: OR 5.50 (3.25-9.32, I²=0%). Repeated: OR 2.19 (1.42-3.38, I²=0%). Aspiration: OR 1.26 (0.86-1.87, NS, I²=34%). Tirzepatide: highest RGC (18.9%). Colonoscopy prep: ↓RGC (OR 0.26). 32,144 GLP-1 + 73,273 controls.

Why it matters

GLP-1 drugs slow gastric emptying, raising fears about aspiration during endoscopy. This large analysis shows the aspiration risk is NOT significantly elevated—the practical impact is more aborted/repeated procedures, manageable with dietary preparation.

How the study worked

Systematic review and meta-analysis. 12 studies, 105,515 patients. Random effects model. Predictive factors analysis. Sensitivity analysis.

What this study cannot tell us

Heterogeneous GLP-1 drug types and doses. Definition of RGC varied. Aspiration events rare (small numbers). Cannot determine optimal GLP-1 hold time.

How to read the evidence

Meta-analysis of 12 studies with 105,515 patients. Consistent RGC findings (I²=0%). Aspiration analysis limited by rare events.

When this study was published

Published in 2025.

The bigger picture

This resolves a major clinical dilemma: GLP-1 drugs do create practical challenges for endoscopy (more food in stomach, more procedure cancellations) but do not significantly increase the dangerous complication of aspiration.

Questions still open

How long should GLP-1 drugs be held before endoscopy?
Should tirzepatide patients have longer fasting periods?
Would routine 24-hour clear liquid diet eliminate the RGC problem?

Common questions

Is it safe to have an endoscopy while on GLP-1 drugs?

Yes—this large analysis shows GLP-1 drugs do NOT significantly increase the risk of aspiration (the main safety concern) during endoscopy. However, they do increase the chance of having food left in the stomach, which may mean your procedure gets delayed or rescheduled. A 24-hour clear liquid diet before the procedure can help reduce this risk.

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

Current guidelines vary. This study suggests that rather than stopping the drug, following a clear liquid diet for 24 hours before the procedure (similar to colonoscopy prep) may be sufficient to reduce retained food. Discuss specific timing with your gastroenterologist.

Read the original research

Evidence Report on the Safety of Gastrointestinal Endoscopy in Patients on Glucagon-like Peptide-1 Receptor Agonists: A Systematic Review and Meta-Analysis.

Diagnostics (Basel, Switzerland), 15(6)

View on PubMed ↗Publisher’s paper ↗

Citation

Tarar, Zahid Ijaz; Farooq, Umer; Chaudhry, Ahtshamullah; Gandhi, Mustafa; El Alayli, Abdallah; Ayoub, Mark; Singh, Baltej; Daglilar, Ebubekir; Thosani, Nirav. (2025). Evidence Report on the Safety of Gastrointestinal Endoscopy in Patients on Glucagon-like Peptide-1 Receptor Agonists: A Systematic Review and Meta-Analysis.. Diagnostics (Basel, Switzerland), 15(6). https://doi.org/10.3390/diagnostics15060770