Surg Endosc. 2026 Jul 9. doi: 10.1007/s00464-026-13121-9. Online ahead of print.
ABSTRACT
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) slow gastric emptying and may therefore increase the risk of retained gastric contents (RGC). The optimal duration of discontinuation before esophagogastroduodenoscopy (EGD) under sedation or general anesthesia remains controversial.
METHODS: We conducted a single-center, retrospective, observational study of patients who underwent elective EGD between August 2023 and May 2025. According to GLP-1RA exposure, patients were classified as (i) no GLP-1RA use, (ii) GLP-1RA continued use, or (iii) GLP-1RA two-week hold. The primary outcome was the presence of RGC, defined as any solid residue or > 100 mL of fluid visualized during EGD. Multivariate logistic regression was used to explore the relationship between GLP-1RA use and RGC.
RESULTS: RGC occurred in 0.4% (63/15902) of patients with no GLP-1RA use, 5.83% (6/103) of patients with GLP-1RA continued use, and 1.61% (1/62) of patients with GLP-1RA two-week hold. GLP-1RA continued use was associated with a tenfold higher RGC risk versus no GLP-1RA use (odds ratio [OR] 10.68, 95% CI 3.74-30.55; p < 0.001), whereas a two-week hold reduced risk to a level statistically comparable with no GLP-1RA use (OR 2.99, 95% CI 0.37-23.89, p = 0.302). Obesity (BMI ≥ 28 kg/m2) independently increased RGC risk and, even after a two-week hold, yielded a tenfold higher risk of RGC versus no GLP-1RA use. Additionally, concurrent colonoscopy exerted a strong protective effect of RGC, and no RGC events occurred in patients with GLP-1RA two-week hold and concurrent colonoscopy.
CONCLUSIONS: A two-week hold of GLP-1RA lowered RGC incidence to a low level comparable with no GLP-1RA use, especially in normal-weight or overweight patients and in those undergoing concurrent colonoscopy, but may be insufficient for obesity.
PMID:42426387 | DOI:10.1007/s00464-026-13121-9
