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Cited by 55Diabetes Treatment and ManagementGastrointestinal Bleeding Diagnosis and TreatmentAirway Management and Intubation Techniques

Glucagon-Like Peptide-1 Receptor Agonists Do Not Increase Aspiration During Upper Endoscopy in Patients With Diabetes

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Barlowe, Trevor S., Anderson, Chelsea, Sandler, Robert S., Subramaniam, Disha, Muratore, Alicia, Buse, John B., Gouker, Lindsey N., Majithia, Rajiv T. +3 more·2025·Clinical Gastroenterology and Hepatology
DOI 10.1016/j.cgh.2024.04.038PMC PMC11564414
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Abstract

Background & aims Glucagon-like peptide-1-receptor agonists (GLP1-RAs) have been associated with greater retention of gastric contents, however, there is minimal controlled, population-based data evaluating the potential adverse effects of GLP1-RA in the periprocedural setting. We aimed to determine if there is increased risk of aspiration and aspiration-related complications after upper endoscopy in patients using GLP1-RAs. Methods We used a nationwide commercial administrative claims database to conduct a retrospective cohort study of patients aged 18 to 64 with type 2 diabetes who underwent outpatient upper endoscopy from 2005 to 2021. We identified 6,806,046 unique upper endoscopy procedures. We compared claims for aspiration and associated pulmonary adverse events in the 14 days after upper endoscopy between users of GLP1-RAs, dipeptidyl peptidase 4 inhibitors (DPP4is), and chronic opioids. We adjusted for age, sex, Charlson Comorbidity score, underlying respiratory disease, and gastroparesis. Results We found that pulmonary adverse events after upper endoscopy are rare, ranging from 6 to 25 events per 10,000 procedures. When comparing GLP1-RAs with DPP4i, crude relative risks of aspiration (0.67; 95% CI, 0.25-1.75), aspiration pneumonia (0.95; 95% CI, 0.40-2.29), pneumonia (1.07; 95% CI, 0.62-1.86), or respiratory failure (0.75; 95% CI, 0.38-1.48) were not higher in patients prescribed a GLP1-RA. When comparing GLP1-RAs with opioids, crude relative risks were 0.42 (95% CI, 0.15-1.16) for aspiration, 0.60 (95% CI, 0.24-1.52) for aspiration pneumonia, 0.30 (95% CI, 0.19-0.49) for pneumonia, and 0.24 (95% CI, 0.13-0.45) for respiratory failure. These results were consistent across several sensitivity analyses. Conclusions GLP1-RA use is not associated with an increased risk of pulmonary complications after upper endoscopy compared with DPP4i use in patients with type 2 diabetes.

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  • In a retrospective cohort of 6,806,046 patients with T2DM who underwent outpatient upper endoscopy from 2005 to 2021, relative risks for aspiration, aspiration pneumonia, pneumonia, or respiratory failure were not elevated in patients prescribed GLP-1 RA compared to those receiving DPP-4 inhibitors.

    “However, a recent retrospective cohort study using a nationwide commercial administrative claims database— including 6,806,046 patients with T2DM who underwent outpatient upper endoscopy from 2005 to 2021—reported contrasting findings. It showed that the relative risks for aspiration, aspiration pneumonia, pneumonia, or respiratory failure were not elevated in patients prescribed GLP-1 RA compared”

    From Exploring the Side Effects of GLP-1 Receptor Agonist: To Ensure Its Optimal Positioning (2025) · cites this paper as [21]

    The Abstract (Results) and Results (Primary analysis) report that aspiration, aspiration pneumonia, pneumonia, and respiratory failure risks were not higher in GLP1-RA users than in DPP4i users. But the Abstract (Methods) identifies 6,806,046 as unique upper-endoscopy procedures, not patients with T2DM; Results (Overview of the population) says 274,211 outpatient procedures involved patients with T2DM who met the inclusion criteria. (LLM, conf=0.93)

    Experimental — accuracy not yet measured

  • Population-based studies have reported mixed findings on the potential association between GLP-1RA use and aspiration pneumonia.

    “Population-based studies have reported mixed findings on the potential association between GLP-1RA use and aspiration pneumonia (39–44).”

    From The science of safety: adverse effects of GLP-1 receptor agonists as glucose-lowering and obesity medications (2026) · cites this paper as [42]

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Authors
Barlowe, T. S., Anderson, C., Sandler, R. S., Subramaniam, D., Muratore, A., Buse, J. B., Gouker, L. N., Majithia, R. T., Shaheen, N. J., Stürmer, T., & Dougherty, M. K.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Rex Hospital (US)
Corresponding author
  • Barlowe, Trevor S.
  • Dougherty, Michael K.
ORCID
Venue
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Published
2025-04
Volume
23
Issue
5
Pages
739-747
ISSN
1542-3565 (ISSN-L)
DOI
10.1016/j.cgh.2024.04.038
PMC
PMC11564414
OpenAlex
W4396919050
Cited by
55
References
9
Citations by year
2026: 14 · 2025: 30 · 2024: 11
FWCI
18.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Gastroenterology and Hepatology (acceptedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
National Institutes of Health (T32 DK007634, P30 DK034987)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Keywords
GLP-1 receptor agonists, aspiration, upper gastrointestinal endoscopy, type 2 diabetes, aspiration pneumonia, pulmonary adverse events, DPP-4 inhibitors, gastroparesis, respiratory failure, drug safety, procedural complications, antidiabetic drugs
MeSH terms
Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Adolescent, Adult, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Male, Middle Aged, Retrospective Studies, Endoscopy, Gastrointestinal, Respiratory Aspiration, Dipeptidyl-Peptidase IV Inhibitors, Young Adult

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