Effect of GLP-1 receptor agonists on upper gastrointestinal endoscopy outcomes: a systematic review and meta-analysis

Konstantinos Malandris; Savvas Papachristou; Lito Psychou Derka; Georgios Kalopitas; Eleni Gkoura; Aris Liakos; Thomas Karagiannis; Eleni Theocharidou; Anastasios Manolakis; Eleni Bekiari; Apostolos Tsapas

Authors Konstantinos Malandris, Savvas Papachristou, Lito Psychou Derka, Georgios Kalopitas, Eleni Gkoura, Aris Liakos, Thomas Karagiannis, Eleni Theocharidou, Anastasios Manolakis, Eleni Bekiari, Apostolos Tsapas.

Abstract

Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about potential aspiration risk during upper gastrointestinal (GI) endoscopy. We conducted a systematic review and meta-analysis to evaluate the effect of GLP-1 RA therapy on procedural outcomes in patients undergoing upper GI endoscopy.

Methods We searched Medline and Cochrane library up to July 2025 without restrictions. Eligible studies evaluated patients undergoing upper GI endoscopy, comparing those taking GLP-1 RAs with those who were not. Outcomes of interest were the incidence of retained gastric contents (RGC), bronchopulmonary aspiration, and procedure discontinuation. Pooled estimates are expressed as odds ratios (ORs) with 95% confidence intervals (CIs), using a random-effects metaanalysis with inverse variance weighting.

Results Twenty-four observational studies, predominantly retrospective, met the inclusion criteria: these comprised 184,707 participants, of whom 59,095 were taking GLP-1 RAs. Mean age was 58.7 years, 48.8% were women, and 51.2% had type 2 diabetes. Use of GLP-1 RAs was associated with higher rates of RGC (OR 4.82, 95%CI 3.66-6.35) and procedure discontinuation (OR 3.93, 95%CI 2.42-6.39) compared with control treatment. In contrast, the incidence of aspiration events was similar between groups (OR 1.1, 95%CI 0.84-1.48). Results remained consistent in a sensitivity analysis based on propensity score matching to control for confounders.

Conclusions GLP-1 RA therapy is associated with a greater incidence of RGC and higher rates of endoscopy termination, but not with a higher risk of aspiration. Adjusting the fasting duration, rather than routinely discontinuing GLP-1 RAs, may represent a reasonable management approach.

Keywords Upper gastrointestinal endoscopy, glucagon-like peptide-1 receptor agonists, systematic review, meta-analysis

Ann Gastroenterol 2026; 39 (4): 452-463