Risk of Aspiration Pneumonitis After Elective Esophagogastroduodenoscopy in Patients on Glucagon-Like Peptide-1 Receptor Agonists
Open accessAbstract
Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are gaining popularity in the management of diabetes mellitus and obesity. It has been suggested that this class of medications causes delayed gastric emptying which raised concerns about the potential for aspiration of gastric contents in patients undergoing sedation. This led to a statement by the American Society of Anesthesiologists about their preoperative use. Nevertheless, there is minimal evidence regarding the effects of GLP-1RAs on the risk of aspiration post-esophagogastroduodenoscopy (EGD). In this study, we sought to evaluate the incidence of aspiration and pneumonia in patients receiving GLP-1RAs who underwent EGD. Methodology We performed a retrospective cohort study in TriNetX, a global federated research network of electronic health records. The primary outcome was the development of aspiration post-EGD. Secondary outcomes were the development of aspiration pneumonia and requiring antibiotics post-EGD. One-to-one propensity score matching was performed for age, sex, diabetes mellitus, obesity, and other comorbidities between the cohorts. Results Our analysis showed a small but significant risk of aspiration pneumonitis in patients on GLP-1RAs undergoing elective EGD compared to non-GLP-1RA-receiving patients. However, there was no increased risk of the composite outcome of respiratory failure or intensive care unit (ICU) admission; however, this did not reach statistical significance. Conclusions GLP-1RA use was associated with an increased risk of aspiration in patients undergoing elective upper endoscopy. However, this did not translate to an increased risk of respiratory failure or ICU admission. Our findings highlight the importance of following an individualized approach to preoperative management that takes into consideration GLP-1RA indications and other aspiration risk factors, including advanced age, impaired gag reflex, and gastrointestinal symptoms such as nausea and abdominal distention.
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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 [40]
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- Authors
- Al Sakka Amini, R., Ismail, A.-L. S., Al-Aqrabawi, M., Aleyadeh, W., Mohammed, A., Altork, N., Abosheaishaa, H., Elfert, K. A., Goble, S. R., Sawaf, B., & Chandan, S.
- Affiliations
- Cleveland Clinic Akron General (US)
- AdventHealth Orlando (US)
- Washington Hospital (US)
- Cairo University (EG)
- St. Barnabas Hospital (US)
- Hamad Medical Corporation (QA)
- Creighton University (US)
- ORCID
- Venue
- Cureus
- Published
- 2024-08-06
- Volume
- 16
- Issue
- 8
- Pages
- e66311-e66311
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC11376965
- OpenAlex
- W4401379720
- Cited by
- 13
- References
- 14
- Citations by year
- 2026: 2 · 2025: 11
- FWCI
- 4.28
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- GLP-1 receptor agonists, aspiration pneumonitis, upper gastrointestinal endoscopy, aspiration pneumonia, delayed gastric emptying, preoperative sedation, respiratory failure, intensive care unit admission, antibiotic use, preoperative care
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