GLP-1/GIP Agonists & Endoscopy: Gastric Volume Risk & Clear Liquid Solution

Patients undergoing upper endoscopy who are also taking medications like Ozempic or Wegovy—GLP-1 or GLP-1/GIP agonists—may demand to temporarily pause their treatment or adhere to a clear liquid diet the day before the procedure. New research suggests continuing these medications can significantly increase the risk of retained gastric contents, potentially complicating the endoscopy. This finding is prompting a re-evaluation of periprocedural management for individuals on these increasingly common drugs.

Understanding Residual Gastric Volume and Endoscopy

An upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a procedure where a thin, flexible tube with a camera is used to visualize the esophagus, stomach, and duodenum. It’s a crucial diagnostic tool for a range of gastrointestinal issues. Yet, a clear view requires the stomach to be relatively empty. Residual gastric volume (RGV)—the amount of food or liquid remaining in the stomach—can obstruct the view, potentially requiring the procedure to be aborted or increasing the risk of aspiration (stomach contents entering the lungs). Aspiration can lead to pneumonia or other respiratory complications.

GLP-1 and GIP agonists operate by slowing gastric emptying, meaning food stays in the stomach longer. This represents one of the mechanisms by which they promote weight loss and improve blood sugar control in people with type 2 diabetes. However, this same effect can create challenges during endoscopic procedures.

The Recent Study: Holding vs. Continuing Medication

A randomized clinical trial, conducted at two large US medical centers between July 2024 and May 2025, investigated whether stopping GLP-1/GIP agonists before an endoscopy reduced the risk of clinically significant RGV. The study, published in JAMA Internal Medicine and further detailed on PubMed, involved 60 patients scheduled for elective upper endoscopy. Participants were randomly assigned to either continue their medication as usual or hold one dose prior to the procedure.

The primary outcome was clinically significant RGV, defined as gastric contents that either prevented a complete endoscopic examination, necessitated premature termination or intubation, or resulted in an aspiration event requiring extended observation, treatment, or hospitalization. Preliminary results from an interim analysis showed that clinically significant RGV occurred in 3.1% of the patients who held their medication, compared to 25% in the group that continued taking it. These findings suggest a substantial benefit to temporarily discontinuing the medication before endoscopy.

Study Limitations and What They Mean

It’s important to note that this was an interim analysis, meaning the full study results are still pending. The sample size of 60 patients is relatively small, and the findings may not be generalizable to all populations. The study also excluded patients with certain pre-existing conditions, such as gastroparesis or prior foregut surgery, which could affect gastric emptying. The study did not specifically investigate the impact of a clear liquid diet. The researchers acknowledge that high-quality data were lacking to guide periprocedure management of these medications prior to the study.

Clear Liquid Diets: A Potential Mitigation Strategy

While holding the medication appears beneficial, completely fasting before an endoscopy isn’t always practical or comfortable for patients. Recent reporting from Medscape Medical News highlights that adhering to a clear liquid diet the day before the procedure may mitigate the risk of RGV even if the medication isn’t stopped. Clear liquids—such as water, clear broth, and clear juices—pass through the stomach more quickly than solid foods, potentially reducing the volume of retained gastric contents.

However, the optimal approach—whether to hold the medication, follow a clear liquid diet, or combine both—remains to be definitively established. Individual patient factors, such as the type of GLP-1/GIP agonist used, the duration of treatment, and the indication for endoscopy, will likely influence the best course of action.

Who is Affected by These Findings?

These findings primarily affect the growing number of individuals using GLP-1 or GLP-1/GIP agonists for the treatment of type 2 diabetes or obesity. These medications have become increasingly popular in recent years, with millions of prescriptions written worldwide. Anyone scheduled for an upper endoscopy while taking these drugs should discuss the potential risks and benefits of different periprocedural management strategies with their healthcare provider.

What Does This Mean for Patients?

This research doesn’t mean patients should stop taking their medications. GLP-1 and GIP agonists are effective treatments for diabetes and obesity, and the benefits generally outweigh the risks. However, it does emphasize the importance of clear communication between patients and their doctors regarding medication management before endoscopic procedures. Patients should not make any changes to their medication regimen without consulting their healthcare provider.

Risk Context: Understanding the Numbers

The reported 25% RGV rate in the continuation group, while significant, needs context. The absolute risk difference between continuing and holding the medication was substantial in this interim analysis. However, it’s crucial to remember this was a selected population undergoing endoscopy, and the overall risk of complications from endoscopy is relatively low. The study highlights a way to further reduce that risk in patients on these medications.

What Comes Next: Ongoing Research and Guidance Updates

The researchers are continuing to analyze the full dataset from the clinical trial, and the complete results are expected to provide more definitive guidance on periprocedural management of GLP-1/GIP agonists. Professional societies, such as the American Society for Gastrointestinal Endoscopy (ASGE), are likely to review the findings and update their recommendations accordingly. Ongoing surveillance of RGV rates in patients undergoing endoscopy will also assist to refine best practices. Patients should check with their healthcare providers for the most up-to-date guidance.