Should patients stop GLP-1 drugs before an endoscopy? A randomized trial finds the answer is complicated

Millions of people now take GLP-1 receptor agonists - drugs like semaglutide and tirzepatide prescribed for diabetes and weight loss. These medications work partly by slowing gastric emptying, which raises an uncomfortable question for anyone who needs an upper endoscopy: will there be food sitting in their stomach when the scope goes in?

Residual gastric contents during endoscopy are not just inconvenient. They obscure the view, can complicate the procedure, and in rare cases create a risk of aspiration - stomach contents entering the lungs during sedation. Current guidelines from the American Society of Anesthesiologists recommend holding GLP-1 drugs before procedures requiring sedation, but the evidence supporting that recommendation has been thin.

What the trial found

A randomized clinical trial, published in JAMA Internal Medicine, tested the question directly. Patients scheduled for upper endoscopy were randomized to either continue or hold their GLP-1 or GIP agonist medication in the preprocedural period.

The result was nuanced. Continuing the medication did increase clinically significant residual gastric volume - meaning more patients in the continuation group had concerning amounts of stomach contents at the time of the procedure. However, continuing the medication did not increase the risk of other adverse events. No difference in aspiration events or procedural complications emerged between the groups.

The clear-liquid workaround

An important secondary finding may prove more useful in practice: restricting patients to clear liquids the day before the procedure appeared to mitigate the risk of clinically significant residual gastric volume regardless of whether the GLP-1 or GIP medication was continued or held. This suggests that dietary preparation, rather than medication management, may be the more effective lever for reducing gastric content risk.

This matters clinically because holding GLP-1 drugs creates its own problems. For diabetic patients, interrupting glucose-lowering medication risks glycemic instability. For patients using these drugs for weight management, even brief interruptions can disrupt adherence. If a clear-liquid prep achieves the same gastric emptying benefit without medication disruption, the risk-benefit calculation shifts.

What the trial does not resolve

The study addresses upper endoscopy specifically. Whether the findings apply to other sedated procedures - colonoscopy, surgical operations, or other interventions requiring general anesthesia - is not established. The risk profile may differ for procedures with longer sedation times or deeper planes of anesthesia where aspiration risk is inherently higher.

The trial also does not provide long-term follow-up or address the full range of GLP-1 and GIP agonist formulations now on the market, which differ in their pharmacokinetics and degree of gastric emptying delay. Results from a weekly injectable may not translate directly to a daily oral formulation, or vice versa.

For gastroenterologists and anesthesiologists managing the growing population of patients on these medications, the trial provides useful but incomplete guidance. The safest approach may be the simplest: ensure thorough dietary preparation regardless of medication decisions, and make case-by-case judgments about holding the drug based on individual patient risk.