Effects of Glucagon-Like Peptide-1 Receptor Agonists on Upper Gastrointestinal Endoscopy: A Meta-Analysis
Open accessAbstract
BACKGROUND AND AIMS: Limited evidence exists regarding the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on upper endoscopy. Therefore, a meta-analysis was conducted to comprehensively review the available evidence on this subject. METHODS: A systematic bibliographic search was carried out until May 2024. Pooled estimates were analyzed using a random-effects model, with results presented as odds ratio (OR) and 95% confidence interval (CI). The primary outcome assessed was the rate of retained gastric content (RGC), while secondary outcomes included rates of aborted and repeated procedures, adverse event rate, and rates of aspiration. RESULTS: This analysis included 13 studies involving a total of 84,065 patients. Patients receiving GLP-1RA therapy exhibited significantly higher rates of RGC (OR, 5.56; 95% CI, 3.35 to 9.23), a trend that was consistent among patients with diabetes (OR, 2.60; 95% CI, 2.23 to 3.02). Adjusted analysis, accounting for variables such as sex, age, body mass index, diabetes, and other therapies, confirmed the elevated rates of RGC in the GLP-1RA user group (adjusted OR, 4.20; 95% CI, 3.42 to 5.15). Furthermore, rates of aborted and repeated procedures were higher in the GLP-1RA user group (OR, 5.13; 95% CI, 3.01 to 8.75; and OR, 2.19; 95% CI, 1.43 to 3.35; respectively). However, no significant differences were found in AE and aspiration rates between the 2 groups (OR, 4.04; 95% CI, 0.63 to 26.03; and OR, 1.75; 95% CI, 0.64 to 4.77; respectively). CONCLUSION: Use of GLP-1RAs is associated with increased retention of gastric contents and more frequent aborted procedures during upper endoscopy. However, the adverse event and aspiration rates do not seem different; therefore, adjusting fasting time instead of routinely withholding GLP-1RAs could be reasonable in these patients.
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Previous systematic reviews have examined the risk of pulmonary aspiration or residual gastric contents among patients using glucagon-like peptide-1 receptor agonists, but they have been limited to patients undergoing endoscopic procedures or those temporarily exposed to glucagon-like peptide-1 receptor agonists during the immediate peri-operative period.
“Previous systematic reviews have examined the risk of pulmonary aspiration or residual gastric contents among patients using GLP‐1 RAs, but they have been limited to patients undergoing endoscopic procedures [27, 28, 29] or those temporarily exposed to GLP‐1 RAs during the immediate peri‐operative period [30].”
From Association between glucagon-like peptide-1 receptor agonist use and peri-operative pulmonary aspiration: a systematic review and meta-analysis (2025) · cites this paper as [27]
None of these reviews identified an increased risk of aspiration pneumonia.
“Importantly, none of these reviews identified an increased risk of aspiration pneumonia.”
From The science of safety: adverse effects of GLP-1 receptor agonists as glucose-lowering and obesity medications (2026) · cites this paper as [36]
Three systematic reviews reported increased risk for premature termination of endoscopy among GLP-1RA users: Baig et al. OR 4.5, Facciorusso et al. OR 5.6, and Singh et al. OR 13.9.
“Baig et al. (35) and Facciorusso et al. (36) reported an increased risk (odds ratios 4.5 and 5.6, respectively) for premature termination among individuals taking GLP-1RAs, while Singh et al. reported an even greater risk (odds ratio 13.9) (37).”
From The science of safety: adverse effects of GLP-1 receptor agonists as glucose-lowering and obesity medications (2026) · cites this paper as [36]
In some retrospective studies, no increase in risk of aspiration pneumonia was found in association with GLP-1 RAs.
“In some retrospective studies, no increase in risk of aspiration pneumonia was found in association with GLP-1 RAs (159,160).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [160]
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- Authors
- Facciorusso, A., Ramai, D., Dhar, J., Samanta, J., Chandan, S., Gkolfakis, P., Crinò, S. F., Maida, M., Anderloni, A., Boskoski, I., Triantafyllou, K., Dinis-Ribeiro, M., Hassan, C., Fuccio, L., & Arvanitakis, M.
- Affiliations
- University of Foggia (IT)
- Brigham and Women's Hospital (US)
- Post Graduate Institute of Medical Education and Research (IN)
- AdventHealth Orlando (US)
- University of Verona (IT)
- Università degli Studi di Enna Kore (IT)
- Policlinico San Matteo Fondazione (IT)
- National and Kapodistrian University of Athens (GR)
- Humanitas University (IT)
- University of Bologna (IT)
- Erasmus Hospital (BE)
- Corresponding author
- Facciorusso, Antonio
- ORCID
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2025-04
- Volume
- 23
- Issue
- 5
- Pages
- 715-725.e3
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W4401502176
- Cited by
- 59
- References
- 0
- Citations by year
- 2026: 25 · 2025: 28 · 2024: 6
- FWCI
- 3.46
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by-nc-nd)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- GLP-1 receptor agonists, upper gastrointestinal endoscopy, repeat endoscopy, aspiration, adverse events, fasting duration, diabetes mellitus, gastric emptying, endoscopy safety
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Gastrointestinal Contents, Humans, Hypoglycemic Agents, Endoscopy, Gastrointestinal
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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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