DAY 2 - AGA Annual “Battle of the Heavyweights” to Debate Hot Topics in Clinical Care

Should GLP-1 RA be stopped prior to endoscopy?

Andrew Y. Wang, MD, from the University of Virginia Health System in Charlottesville, Virginia, argued that GLP-1 RAs should be stopped prior to endoscopy, based on the biology of GLP-1 to slow gastric emptying and a wealth of literature showing increased gastric retention. A systematic review and meta-analysis by Hiramoto et al. (Am J Gastroenterol. 2024) showed a 36-minute delay,  and Jensterle et al. (Diab Obes Metab. 2023) reported gastric retention in 37% of patients after 13 weeks of GLP-1 RA compared to 7% of patients not taking a GLP-1 RA. In addition, studies have shown that GLP-1 RAs are associated with aspiration pneumonia (Yee et al. Gastroenterol. 2024 and Tan et al. Dig Liver Dis. 2025). Dr. Wang pointed out that withholding GLP-1 RAs is consistent with the existing guidance from the American Society of Anesthesiologists (Kindel et al. Clin Gastro Hepatol. 2024). He also noted that GLP-1 RAs have a long half-life of 1 week, so an 8 hour fast is likely insufficient for patients on daily dose. An ASGE position statement by Sharaiha et al. (Gastroint Endosc. 2025) developed an algorithm to assist in patient selection and the recommended hold times for GLP-1 RAs.

Christopher C. Thompson, MD, from Brigham and Women’s Hospital in Boston, Massachusetts, provided the opposing viewpoint, that in general, GLP-1 RAs should be continued prior to endoscopy, with some exceptions. He noted that the ASA consensus statement recommending withholding GLP-1 RAs for a week led to chaos, with procedures being cancelled, delays in diagnosis, and the risk of interrupting treatment for diabetes because of a scheduled procedure. He noted that there was little data beyond literature reviews and meta-analysis to support the ASA position. He argued that the 36-minute delay reported by Hiramoto et al. is not clinically significant. Other studies have also shown no differences in aspiration risk, residual gastric content, or termination rates in patients taking GLP-1 RAs or not (Jirapinyo et al. Obesity. 2025 and Tarar et al. Diagnostics. 2025). Tarar et al. further showed that extending the fast completely solved the problem. Multi-society guideline recommend that GLP-1 RAs can be continued with caution, and withheld in patients in the escalation phase, taking higher doses, weekly doses, or if there are GI symptoms or co-morbid conditions. Risk can be minimized by fasting longer, using a liquid diet and if needed, point-of-care gastric ultrasound and rapid sequence induction. Dr. Thompson concluded that the lack of studies on GLP-1 RA withholding means that physicians cannot counsel patients on the risk. 

The audience poll and the end of the debate showed that 62% would not stop GLP-1 RAs and 38% would stop GLP-1 RAs prior to endoscopy.