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GLP-1 drugs and endoscopy: balancing safety with clinical demand

By Dannielle Marler

Home » Blogs » GLP-1 drugs and endoscopy: balancing patient safety with clinical demand

Glucagon-like peptide-1 (GLP-1) receptor agonists were originally developed for type 2 diabetes and obesity management alongside diet and exercise. They work by mimicking naturally occurring hormones that regulate appetite and blood glucose, and slow gastric emptying.1 There has recently been a rapid uptake of these products for weight loss, with medicines such as Wegovy®, Ozempic® and Mounjaro® becoming increasingly common. In fact, around 1.6 million adults in Great Britain used GLP-1 medications for weight loss in the 12 months from 2024 to 2025, while more than 8 million have considered, or attempted, accessing them.2 A significant number of these individuals currently receive GLP-1 medicines through private prescriptions because of the lack of NHS capacity and NICE eligibility restrictions.

The hidden impacts of GLP-1 therapies on endoscopy

GLP-1s have been valuable aids for individuals living with diabetes or who need weight loss support. However, they have also had unexpected consequences on the healthcare industry due to their effect on stomach emptying. Patients awaiting gastroscopy must fast prior to the procedure to empty their stomach contents, otherwise clear visualisation of the gastric mucosa is not possible. But also, inadequate gastric emptying carries a perceived risk of pulmonary aspiration during sedation, since residual stomach contents can passively reflux under anaesthesia allowing this refluxed material to enter the windpipe and lungs. Current evidence shows no significant increase in aspiration events despite increased residual gastric contents,4 but other underlying risks or potential consequences have not yet been defined.

Despite patients adhering to the recommended fasting period for endoscopy, residual gastric contents appear higher in those taking GLP-1s due to its effect on gastric emptying. Meta-analysis of 13 studies reported significantly higher rates of residual gastric contents in patients receiving GLP-1 therapy as a direct consequence of delayed gastric emptying and kinetics.3 A smaller study showed clinically significant gastric contents in approximately 25 per cent of patients continuing GLP-1 therapy, compared with around three per cent in those who stopped treatment before endoscopy.4

Although the risks of incomplete gastric emptying are still being defined, it results in delayed or cancelled procedures and modified anaesthetic plans. Reports have even indicated procedural disruption in up to 30 per cent of cases without adapted protocols.5 This creates additional pressure for already stretched endoscopy departments, which need to constantly reschedule appointments or amend plans.

GLP-1 guidance for endoscopy patients

The increasing use of GLP-1 medication has raised questions around how to prepare patients for procedures requiring sedation, such as gastroscopies. Official recommendations have begun to emerge to provide clarity on this issue. For example, the Association of Anaesthetists in Great Britain and Ireland, as well as the Royal College of Anaesthetists, recommend the continuation of GLP-1 therapy alongside individual risk assessments and aspiration risk mitigation.6,7 In contrast, the American Society of Anaesthesiologists recommends withholding daily GLP-1 medications on the day of the procedure and weekly preparations for one week beforehand.8 These differences in recommendations, the evolving evidence base, and the widespread trend towards patient-specific clinical assessment – rather than blanket policies – creates more uncertainty for gastroenterologists, who must now try to make decisions on a case-by-case basis.

The importance of risk stratification before endoscopy

Increasing GLP-1 use is just the latest factor putting pressure on already stretched endoscopy services. An aging population and changes to existing GI referral pathways are leading to ever-increasing caseloads, despite ongoing staff shortages and resource constraints. This is creating demand for new GI pathways that can reduce reliance on endoscopy as a ‘rule-out’ test for low-risk cases.

GastroPanel® is a straightforward blood test that uses biomarkers to help quickly and reliably identify pathologies of the stomach mucosa, such as chronic atrophic gastritis and stomach cancer risk, as well as Helicobacter pylori infection. The test can be used as a triage tool to help guide patient selection for those taking GLP-1 medication, so that only high-risk patients are referred for endoscopy. This approach helps to eliminate unnecessary endoscopies for many low-risk patients and avoids the potential for complications associated with GLP-1 therapies in this cohort. In turn, this increases patient satisfaction and generates significant cost and time savings for the healthcare system. Reducing the number of endoscopies performed through patient stratification would also shorten waiting times for patients most in need, allowing earlier interventions where necessary.

Managing endoscopy alongside increasing GLP-1 use

GLP-1 therapies are becoming increasingly common in weight management, raising questions as to their clinical and operational ramifications for endoscopy services. Individualised assessment of whether to continue or pause GLP-1 use before endoscopy is likely to remain the preferred approach in Europe until stronger evidence emerges. Improved patient stratification has the potential to enable more efficient use of busy endoscopy services. GastroPanel presents an ideal solution for fast triage, helping to prioritise those in urgent need of gastroscopy and alleviate strain on the healthcare service.

References

  1. GOV. UK. (2026). GLP-1 medicines for weight loss and diabetes: what you need to know. Accessed 26th of June 2026. https://www.gov.uk/government/publications/glp-1-medicines-for-weight-loss-and-diabetes-what-you-need-to-know/glp-1-medicines-for-weight-loss-and-diabetes-what-you-need-to-know
  2. UCL. (2026). 1.6 million UK adults used weight loss drugs in past year. Accessed 26th of June 2026. https://www.ucl.ac.uk/news/2026/jan/16-million-uk-adults-used-weight-loss-drugs-past-year 
  3. Facciorusso, A., et al. (2025). Effects of glucagon-like peptide-1 receptor agonists on upper gastrointestinal endoscopy: a meta-analysis. Clinical gastroenterology and hepatology, 23(5), 715-725.
  4. Ahmad, A. I., et al. (2026). Holding vs continuing GLP-1/GIP agonists before upper endoscopy: the OCULUS randomized clinical trial. JAMA internal medicine, 186(5), 578-584
  5. Crespo, J., et al. (2025). GLP-1 Receptor Agonists and Gastrointestinal Endoscopy: A Narrative Review of Risks, Management Strategies, and the Need for Clinical Consensus. Journal of Clinical Medicine, 14(15), 5597
  6. Association of Association of Anaesthetists in Great Britain and Ireland. (2025). Elective peri-operative management of adults taking glucagon-like peptide-1 receptor agonists, glucose-dependent insulinotropic peptide agonists and sodium-glucose cotransporter-2 inhibitors: a multidisciplinary consensus statement. Accessed 26th of June 2026 https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16541
  7. Royal College of Anaesthetists. (2025). GLP-1 and dual GIP/GLP-1 receptor agonists: potential risk of pulmonary aspiration during general anaesthesia and deep sedation. Accessed 26th of June 2026 https://rcoa.ac.uk/news/glp-1-dual-gipglp-1-receptor-agonists-potential-risk-pulmonary-aspiration-during-general
  8. Singh, S., et al. (2024). Impact of GLP-1 receptor agonists in gastrointestinal endoscopy: an updated review. Journal of clinical medicine, 13(18), 5627.