Effect of glucagon-like peptide-1 receptor agonists on gastric mucosal visibility during upper endoscopy in Asian patients with diabetes

No SJR dataJan 2, 2026World journal of diabetes

How diabetes drugs called GLP-1 receptor agonists affect stomach lining visibility during upper endoscopy in Asian patients

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Abstract

The rate of inadequate gastric mucosal visibility was 8.6% in the GLP-1 receptor agonist group compared to 1.4% in the DPP4 inhibitor group.

GLP-1 receptor agonist treatment is associated with a significantly higher rate of inadequate gastric mucosal visibility during upper endoscopy.
The odds of experiencing inadequate gastric mucosal visibility are more than six times greater in patients using GLP-1 receptor agonists.
Aborted endoscopy procedures occurred significantly more frequently in the GLP-1 receptor agonist group (7.6%) compared to the DPP4 inhibitor group (0.7%).
GLP-1 receptor agonist use is identified as an independent risk factor for both inadequate gastric mucosal visibility and aborted endoscopy procedures.
No cases of pulmonary aspiration were reported in either treatment group during the study.

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BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being used to treat type 2 diabetes mellitus (T2DM) and obesity. Although GLP-1RAs delay gastric emptying, their impact on gastric mucosal visibility during upper endoscopy remains uncertain, especially in Asian patients.

AIM: To investigate the association between GLP-1RA treatment and gastric mucosal visibility during upper endoscopy in Asian patients with T2DM.

METHODS: The study population included Korean patients who underwent esophagogastroduodenoscopy (EGD) with concomitant GLP-1RA or dipeptidyl peptidase 4 inhibitor (DPP4i) for the treatment of T2DM. A 1:2 propensity score matching between GLP-1RA and DPP4i users resulted in 198 matched patients and 295 matched patients in each group, respectively. Gastric mucosal visibility was assessed by reviewing endoscopy images with a validated scale (POLPREP). In addition, the rates of aborted and repeat EGD and pulmonary aspiration were also assessed.

RESULTS: Of the 493 matched patients, mean body mass index was 26.0 kg/m. The rate of inadequate gastric mucosal visibility (gastric POLPREP score 0 or 1) was significantly higher in GLP-1RA group than matched DPP4i group (8.6%1.4%,= 0.0007). The rates of aborted EGD and repeat EGD were also significantly higher in GLP-1RA than DPP4i group (7.6%0.7% in both aborted and repeat EGD,= 0.0011). Multivariable logistic regression revealed GLP-1RA use as an independent risk factor for both inadequate gastric mucosal visibility (odds ratio = 6.143, 95% confidence interval: 2.289, 20.318,= 0.0008) and aborted EGD (odds ratio = 11.099, 95% confidence interval: 3.172, 63.760,= 0.0010). Despite gastric residue, no pulmonary aspiration was reported in either group. 2vs P vs P P P

CONCLUSION: GLP-1RA use was associated with a higher risk of inadequate gastric mucosal visibility and aborted and repeat procedures during upper gastrointestinal endoscopy in Korean patients with T2DM while pulmonary aspiration was not observed.

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