Impact of Discontinuing GLP-1 Receptor Agonists for Two Weeks Prior to Upper Endoscopy on the Risk of Gastric Retention

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including semaglutide, liraglutide, and dulaglutide, are widely used for the management of type 2 diabetes and obesity. These agents improve glycemic control in part by delaying gastric emptying, but this pharmacologic effect may increase the risk of retained gastric contents (RGC) and aspiration during anesthesia or sedation. In 2023, the American Society of Anesthesiologists (ASA) and the American Society for Gastrointestinal Endoscopy (ASGE) issued recommendations to withhold GLP-1RAs before procedures; however, the optimal discontinuation interval remains uncertain.

Using the electronic medical record system of Huadong Hospital, this retrospective study analyzed patients who underwent upper endoscopy between August 2023 and May 2025 to examine the association between different GLP-1RA exposure patterns and the risk of RGC, providing evidence to inform optimization of pre-procedural discontinuation strategies.

Inclusion criteria

• Undergoing elective upper endoscopy
• Complete clinical information available, including endoscopy report, age, sex, BMI, history of diabetes, prior gastric surgery, and gastrointestinal symptom

Exclusion criteria

• Presence of upper gastrointestinal malignancy or obstruction
• History of gastric surgery (including ESD, gastrectomy, gastric bypass, etc.)
• Emergency endoscopy or non-elective procedures
• Missing key clinical information