GLP-1 Receptor Agonists and Endoscopy: Understanding Gastric Stasis, Aspiration Risk, and Contemporary Peri-Procedural Guidance.
GLP-1 receptor agonists may slow gastric emptying but do not significantly increase aspiration risk during endoscopy. Continue therapy with dietary and procedural precautions.
Where it sits
this study against the rest of the exenatide corpusSummary and findings
This review examines the impact of GLP-1 receptor agonists, such as Exenatide, on gastric motility and the associated risks during gastrointestinal endoscopy. It synthesizes data from various studies to assess the incidence of retained gastric contents and aspiration risk. The review suggests that while GLP-1RAs increase procedural disruptions, they do not significantly raise the risk of aspiration pneumonia.
Abstract
The global increase in obesity, type 2 diabetes mellitus (T2DM), and metabolic dysfunction-associated steatotic liver disease (MASLD) has led to a higher use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among patients undergoing gastrointestinal endoscopy. Although GLP-1RAs provide significant metabolic, cardiovascular, and hepatic benefits, their tendency to slow gastric emptying has raised concerns about retained gastric contents (RGC), procedural complications, and a greater risk of pulmonary aspiration during sedation or anesthesia. This review offers a translational narrative synthesis of mechanistic, physiological, and clinical evidence connecting GLP-1RA therapy to changes in gastric motility and peri-endoscopic outcomes. Data from pharmacological studies, scintigraphic evaluations, large observational cohorts, and international consensus statements are combined to guide physiology-based procedural decisions. Evidence consistently indicates that GLP-1RA exposure is associated with a higher incidence of RGC and more frequent procedural disruptions during upper gastrointestinal endoscopy. However, it remains uncertain whether RGC leads to clinically significant aspiration. Consistent with this, real-world data reveal no increase in aspiration pneumonia among GLP-1RA users undergoing colonoscopy, with reported aspiration rates of approximately 0.01%-0.05%. Likewise, during upper gastrointestinal endoscopy, only a small absolute rise in aspiration-related events has been observed, involving fewer than 0.3% of procedures. Current guidelines favor continuing GLP-1RA therapy alongside dietary modification, structured risk assessment, selective gastric point-of-care ultrasound (POCUS), and multidisciplinary communication, rather than routine cessation. Emerging prospective evidence indicates that implementing a pre-procedural clear liquid diet, with individualized timing of weekly agents, may reduce the risk of clinically significant RGC, complementing existing dietary preparation strategies.
Background
The study addresses the concern that GLP-1 receptor agonists, used increasingly due to rising obesity and T2DM rates, may slow gastric emptying and increase risks during endoscopic procedures. Understanding these risks is crucial as GLP-1RAs are widely used for their metabolic benefits. The study is important for guiding peri-procedural management in patients on GLP-1RAs.
Methods
This is a narrative review synthesizing mechanistic, physiological, and clinical evidence from pharmacological studies, scintigraphic evaluations, and large observational cohorts. It also incorporates international consensus statements to provide guidance on peri-procedural management.
Results
The review finds that GLP-1RA therapy is associated with an increased incidence of retained gastric contents and procedural disruptions during upper gastrointestinal endoscopy. However, aspiration pneumonia rates remain low, with colonoscopy rates at 0.01%-0.05% and less than 0.3% for upper endoscopy. Guidelines suggest continuing GLP-1RA therapy with dietary modifications and risk assessments.
Interpretation
While the association between GLP-1RAs and retained gastric contents is clear, the clinical impact in terms of aspiration risk is minimal. This aligns with prior literature suggesting that while gastric stasis is a concern, it does not translate into a significant increase in aspiration events. The findings support current guidelines that recommend continuing GLP-1RA therapy with appropriate procedural precautions.
Key findings
- GLP-1RA exposure is linked to a higher incidence of retained gastric contents.
- Aspiration rates during colonoscopy are approximately 0.01%-0.05%.
- Aspiration-related events occur in fewer than 0.3% of upper gastrointestinal endoscopies.
- Current guidelines recommend continuing GLP-1RA therapy with dietary modifications.
- Pre-procedural clear liquid diet may reduce the risk of significant retained gastric contents.
Limitations
- Observational data reliance
- Uncertain clinical significance of retained gastric contents
- Potential bias from consensus statements
- Lack of randomized controlled trials