Glucagon-Like Peptide-1 Receptor Agonists and Peri-Procedural Aspiration Risk.

Context: Delayed gastric emptying caused by glucagon-like peptide-1 receptor agonists (GLP-1RAs) has raised concerns about increased aspiration risk during surgical and endoscopic procedures. In June 2023, the American Society of Anesthesiologists (ASA) recommended discontinuing GLP-1RAs one day (daily users) or one week (weekly users) before elective surgery or endoscopic esophagogastroduodenoscopy (EGD). In October 2024, the ASA reversed the initial recommendation and advised most patients to continue taking GLP-1RAs before elective surgery.

Objective: We conducted a systematic review of the evidence for or against the original recommendation.

Methods: We searched PubMed for retrospective cohort studies published between June 2023 and March 2025 investigating the association between GLP-1RA use and the risk of aspiration/pneumonia in patients undergoing elective surgery or endoscopic procedures. We calculated a summary risk ratio for studies that could be combined.

Results: We identified 3 studies of elective surgery and 4 of EGD using large databases to identify an increased risk of aspiration/pneumonia associated with GLP-1RA use. The 3 elective surgery studies had a combined risk ratio of 1.00 [0.76, 1.30]. The 4 EGD studies had a combined risk ratio of 1.10 [0.95, 1.27]. In one study, a parallel analysis of the aspiration/pneumonia risk associated with opioid medications found a risk ratio of 2.68 [1.89, 3.81], indicating that the methodology could detect an increased risk of aspiration/pneumonia from a motility inhibitor.

Conclusion: Although GLP-1RAs cause delayed gastric emptying, retrospective cohort studies using large real-world evidence databases have not consistently identified a GLP-1RA-associated risk of aspiration/pneumonia for elective surgical and endoscopic procedures.