Aspiration Risk During Endoscopic Procedures While on GLP-1 Agonist Therapy

Abstract

Background: GLP-1 receptor agonists (GLP-1RAs) are increasingly prescribed for Type 2 diabetes and weight management. Given their effect on gastric emptying, concerns have emerged regarding aspiration risk during endoscopic procedures. While aspiration risk is recognized during esophagogastroduodenoscopy (EGD), data on GLP-1RA users-particularly those undergoing colonoscopy-are limited. This study evaluated aspiration risk in patients undergoing EGD versus colonoscopy while on GLP-1RA therapy.

Methods: We performed a retrospective cohort study of adult patients (18-70 years) who underwent EGD or colonoscopy at Baylor Scott & White Medical Center Temple from July 2017 to July 2024. Patients were stratified by GLP-1RA use. The primary outcome was aspiration-related diagnosis within 30 days, identified via ICD-10 codes. Chi-square testing and logistic regression were used to assess associations.

Results: Among 13,523 patients (7431 EGD; 6092 colonoscopy), 713 (5.3%) were GLP-1RA users. Aspiration events were more frequent following EGD than colonoscopy (adjusted OR = 2.36, P = 0.0200). No aspiration events occurred in GLP-1RA users. Multivariable analysis identified Black race as independently associated with increased aspiration risk (adjusted OR = 2.77, P = 0.0061), while higher BMI was associated with lower aspiration risk. GLP-1RA users had higher BMI and more frequent diabetes and gastroparesis, but no independent association with aspiration risk was observed.

Conclusion: Aspiration risk was significantly higher with EGD than colonoscopy, but GLP-1RA use did not increase aspiration risk for either procedure. These findings suggest that routine GLP-1RA use may not be associated with increased aspiration risk in the outpatient setting. Prospective studies are needed to guide risk-based peri-procedural management.

Keywords: Aspiration pneumonia; Colonoscopy; Delayed gastric emptying; EGD; GLP-1 receptor agonists.