Impact of Glucagon‐Like Peptide‐1 Receptor Agonists on Retained Gastric Contents During Esophagogastroduodenoscopy: A Propensity Score‐Matched Study

Aug 17, 2025Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society

Glucagon-Like Peptide-1 Drugs and Food Left in the Stomach During Upper Digestive Tract Examination

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Abstract

RGC occurred more frequently in the GLP-1 RA group at 12.2% compared to 3.4% in the non-GLP-1 RA group after matching.

GLP-1 receptor agonists are associated with an increased incidence of retained gastric contents during esophagogastroduodenoscopy.
The risk of retained gastric contents was significantly higher in patients using GLP-1 RA compared to those not using it.
Subgroup analyses indicated that this association holds even for patients without a history of peptic ulcer scars or endoscopic treatment.
Patients receiving GLP-1 RA underwent more repeated EGD procedures, but no cases of aspiration pneumonia were reported.

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OBJECTIVES: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are commonly used for diabetes management and are associated with delayed gastric emptying, raising concerns about an increased risk of retained gastric contents (RGC) during esophagogastroduodenoscopy (EGD). While this association has been investigated in Western populations, limited data are available for Asian populations.

METHODS: We conducted a retrospective study involving 1324 patients with diabetes who underwent screening EGD between January 2020 and December 2023. Propensity score matching was used to compare 148 patients receiving GLP-1 RA with 148 patients not receiving GLP-1 RA. We evaluated the relationship between GLP-1 RA use and the incidence of RGC during EGD.

RESULTS: RGC occurred more frequently in the GLP-1 RA group compared to the non-GLP-1 RA group, both before (12.0% vs. 3.7%, p < 0.001) and after matching (12.2% vs. 3.4%, p = 0.009). The association between GLP-1 RA use and RGC remained consistent in subgroup analyses, including patients without a history of peptic ulcer scars or endoscopic treatment as well as those not receiving DPP-4 inhibitors. Repeated EGD procedures were more frequent in the GLP-1 RA group; however, no cases of aspiration pneumonia after EGD were observed.

CONCLUSIONS: The use of GLP-1 RA in patients with diabetes significantly increases the risk of RGC during EGD in Asian populations. Implementing precautions, such as recommending a liquid diet the day before EGD, may help mitigate this risk in clinical practice.

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Impact of Glucagon‐Like Peptide‐1 Receptor Agonists on Retained Gastric Contents During Esophagogastroduodenoscopy: A Propensity Score‐Matched Study

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