NEJM Clinician: Should We Hold GLP-1–Based Medications Before Upper Endoscopy?

Why It Matters

Because GLP‑1–based weight‑loss drugs can cause gastric retention, failing to hold them before sedation may lead to cancelled endoscopies, increasing costs and patient risk.

Key Takeaways

• GLP-1 agonists delay gastric emptying, affecting endoscopy fasting
• Study: 25% procedural failure when medication not held
• Holding the dose reduced failure rate to 3%
• Trial stopped early due to striking difference in outcomes
• Skipping one GLP-1 dose likely safe, avoids repeat procedures

Summary

Clinicians are debating whether to hold GLP‑1 receptor agonists before elective upper endoscopy, given these drugs’ known effect on gastric motility. A recent randomized trial published in JAMA Internal Medicine enrolled 60 patients on semaglutide or tirzepatide scheduled for routine endoscopy. Half continued their usual dose, while the other half omitted the last dose. The study found that 25 % of patients who remained on therapy had residual food or fluid that cancelled the procedure, compared with only 3 % of those who held the dose. The striking difference prompted early termination of the trial.

The investigators highlighted that, although no aspiration events occurred, a one‑in‑four failure rate is clinically significant. GLP‑1 agents slow gastric emptying beyond what an overnight fast can overcome, so simply instructing patients to fast is insufficient. Holding a single dose proved safe for most participants and dramatically reduced cancellations.

The authors caution that the sample size is modest, yet the magnitude of effect suggests a practical change in pre‑procedure management. Avoiding a cancelled endoscopy saves the patient the inconvenience, the facility the lost revenue, and the health system additional costs associated with repeat scheduling.

For gastroenterology practices, the takeaway is clear: when a patient is on a GLP‑1‑based weight‑loss medication, advise withholding the morning dose before sedation. This simple step can improve procedural success rates and reduce downstream expenses.

Original Description

NEJM Clinician Editor-in-Chief Raja-Elie Abdulnour, MD, explains a trial that evaluated the clinical impact of continuing vs holding GLP-1–based medications prior to upper endoscopy. Read the key results at clinician.nejm.org.

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