Glucagon‐like peptide‐1 receptor agonist and respiratory complications after endoscopy: A Japanese nationwide cohort study

Oct 10, 2025Diabetes, obesity & metabolism

Glucagon-like peptide-1 drugs and breathing problems after endoscopy in Japan

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Abstract

GLP-1 receptor agonists (GLP-1RAs) were not linked to an increased risk of respiratory complications after esophagogastroduodenoscopy (EGD) in a cohort of 3,568 patients.

The overall incidence of respiratory complications was 0.39% in GLP-1RA users compared to 0.50% in non-users.
There was no significant difference in the risk of severe respiratory complications between the two groups, with rates of 0.11% for GLP-1RA users and 0.077% for non-users.
Numerical trends suggested a higher risk in new users of GLP-1RAs and patients with severe diabetes, though these did not reach statistical significance.
Findings indicate that routine discontinuation of GLP-1RAs before EGD may not be necessary for many stable, long-term users.
Caution is advised for new users and those with severe diabetes due to observed trends in increased risk.

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AIMS: While discontinuation of glucagon-like peptide-1 receptor agonists (GLP-1RAs) before esophagogastroduodenoscopy (EGD) is not universally mandated, safety concerns persist. Evidence remains insufficient for managing specific patient subgroups, particularly in Asian populations. We aimed to provide evidence for stratified risk assessment in a large Japanese cohort.

MATERIALS AND METHODS: This nationwide retrospective cohort study used the Japan Medical Data Center database. We performed 1:4 propensity score matching based on age, sex, insulin use, HbA1c level, chronic respiratory disease, and body mass index to compare patients with diabetes receiving GLP-1RAs (n = 3568) with non-users (n = 14 246). Respiratory and severe complications within 14 days post-EGD were assessed via logistic regression.

RESULTS: GLP-1RA was not associated with an increased risk of overall (0.39% vs. 0.50%; odds ratio [OR] 0.79, 95% confidence interval [CI] 0.44-1.40; p = 0.41) or severe (0.11% vs. 0.077%; 1.45, 0.46-4.56; p = 0.52) respiratory complications. While no subgroup analysis reached statistical significance, numerical trends towards a higher risk were observed in new users (OR 1.43; 95% CI, 0.51-3.98) and patients with severe diabetes (OR 1.28; 95% CI, 0.64-2.52).

CONCLUSIONS: GLP-1RA was not associated with increased post-EGD respiratory complications, suggesting that routine discontinuation may be unnecessary for many stable, long-term users. However, our findings do not support a uniform conclusion of safety for all subgroups. The non-significant trends in new users and patients with severe diabetes warrant a cautious, individualised approach for these potentially vulnerable populations. Further research is needed to definitively clarify this risk.

Key numbers

0.50%

Respiratory Complications Rate

users had 71 complications out of 14,246 patients.

0.077%

Severe Respiratory Complications Rate

Severe complications occurred in 11 of 14,246 patients in the group.

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Glucagon‐like peptide‐1 receptor agonist and respiratory complications after endoscopy: A Japanese nationwide cohort study

Abstract

Key numbers

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