GLP-1 receptor agonists significantly increase the risk of retained gastric contents during upper endoscopy, with nearly 1 in 4 patients affected—and up to 50% in some settings without dietary prep.
What’s changing is not just risk awareness, but protocol thinking. While early guidance pushed for holding these medications, emerging data suggest a simpler intervention—a clear liquid diet the day before the procedure—may mitigate much of the risk without interrupting therapy. At the same time, the absence of increased aspiration events reinforces that the clinical consequences may be more nuanced than initially feared.
This is creating tension between guidelines and real-world practice, with societies split between precautionary holds and individualized decision-making.