Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy

Publication Date: November 7, 2023
Last Updated: November 15, 2023

Summary of Recommendations

There has been increasing concern about performing endoscopic procedures, in particular upper endoscopies, on patients who are using glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1 RAs) due to their effect on slowing gastric motility and the risk of aspiration of retained gastric contents in sedated patients.

Generally, in patients on GLP-1 RAs who have followed standard perioperative procedures (typically an 8-hour solid-food fast and a 2-hour liquid fast) and who do not have symptoms of nausea, vomiting, dyspepsia, or abdominal distention, we advise proceeding with upper and/or lower endoscopy.

In patients with symptoms suggesting possible retained gastric contents, transabdominal ultrasonography can be utilized to assess the stomach—if there is sufficient clinical expertise and the equipment is available—but evidence to support this modality in standard practice is lacking.

In symptomatic patients for whom delaying endoscopy may have negative clinical consequences, rapid-sequence intubation is a consideration; however, this may not be possible in most ambulatory or office-based endoscopy settings.

Lastly, when possible, placing patients on a liquid diet the day before sedated procedures may be a more acceptable strategy, in lieu of stopping GLP-1 RAs, and more consistent with the holistic preprocedural management of other similar conditions.

In closing, we endorse the GI multi-society guidance that “patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on patients on GLP-1 RAs.

Recommendation Grading


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy

Authoring Organization

Publication Month/Year

November 7, 2023

Last Updated Month/Year

November 20, 2023

Supplemental Implementation Tools

Document Type


Country of Publication


Document Objectives

Experts review the available evidence and provide expert advice regarding the evolving management of patients taking GLP-1 receptor agonists prior to endoscopy.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Counseling, Management

Diseases/Conditions (MeSH)

D020776 - Endoscopes, Gastrointestinal, D019723 - Endoscopes, D052216 - Glucagon-Like Peptide 1


glucagon-like peptide 1 (GLP-1), endoscopy, GLP1, GLP-1

Source Citation

Hashash JG, Thompson CC, Wang AY. AGA Rapid Clinical Practice Update on the Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy: Communication. Clin Gastroenterol Hepatol. 2023 Nov 7:S1542-3565(23)00869-8. doi: 10.1016/j.cgh.2023.11.002. Epub ahead of print. PMID: 37944573.

Supplemental Methodology Resources

Data Supplement