S1264 Comparison of Aspiration Risk in Patients Undergoing Upper Endoscopy vs Colonoscopy While on GLP-1 Agonist Therapy

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for Type 2 Diabetes Mellitus and weight management, but their known effect of delaying gastric emptying has raised concerns about increased aspiration risk during endoscopic procedures. While the risk of aspiration during upper endoscopy is recognized, data remains limited and conflicting—particularly regarding GLP-1RA users and colonoscopy. This study aimed to evaluate the risk of aspiration in patients undergoing esophagogastroduodenoscopy otherwise known as EGD versus colonoscopy while on GLP-1RA therapy. Methods: We conducted a retrospective cohort study using electronic health records from the Baylor Scott and White Medical Center Temple hospital-based endoscopy center between July 31, 2017, and July 31, 2024. Adult patients aged 18–70 undergoing EGD or colonoscopy were included and stratified by GLP-1RA use. The primary outcome was aspiration-related events identified via ICD-10 codes within 30 days of the procedure. Chi-square tests and logistic regression were used to compare patient characteristics and assess the association between procedure type, GLP-1RA use, and aspiration risk. Results: Out of 13,523 patients (7,431 EGD; 6,092 colonoscopy), 713 (5.3%) were GLP-1RA users. Aspiration events were more common during EGD than colonoscopy (OR = 2.30, P = 0.0201). Notably, no aspiration events occurred among GLP-1RA users. Male sex was associated with higher aspiration risk (OR = 2.01, P = 0.0293). GLP-1RA users had significantly higher BMI and were more likely to have diabetes and gastroparesis. However, GLP-1RA use was not independently associated with increased aspiration risk. Conclusion: This large retrospective study demonstrates that aspiration risk is significantly higher in patients undergoing upper endoscopy compared to colonoscopy. Importantly, GLP-1RA therapy was not associated with increased aspiration risk during either procedure. These findings suggest that while procedure type influences aspiration risk, GLP-1RAs may not necessitate withholding prior to endoscopy in otherwise low-risk patients. Further prospective studies are warranted to refine risk stratification and optimize peri-procedural management in this growing patient population.