Review finds no consistent aspiration risk signal for GLP-1 drugs before procedures
A new review finds large real-world databases have not consistently linked GLP-1 drugs to aspiration or pneumonia around surgery or endoscopy, leaving the call to patients and their care teams.
A review published in the Journal of the Endocrine Society found that large real-world databases have not consistently shown that GLP-1 medications raise the risk of aspiration or pneumonia around elective surgery or upper endoscopy [1].
The review, a systematic review and meta-analysis by Cindy N. Ho, Alessandra T. Ayers, Michael A. Kohn, Guillermo E. Umpierrez and David C. Klonoff, appeared July 10, 2025 in volume 9, issue 9 of the journal [1]. The authors searched PubMed for retrospective cohort studies published between June 2023 and March 2025 that compared GLP-1 receptor agonist users with nonusers for aspiration or pneumonia after elective surgery or esophagogastroduodenoscopy (EGD), a camera exam of the upper digestive tract [1].
They combined three studies of elective surgery and four studies of EGD that drew on large databases [1]. The surgery studies had a combined risk ratio of 1.00, with a 95 percent confidence interval of 0.76 to 1.30 [1]. The EGD studies had a combined risk ratio of 1.10, with a 95 percent confidence interval of 0.95 to 1.27 [1]. A risk ratio of 1.00 means no difference between the groups; intervals that cross 1.0 include the possibility of no effect.
The authors pointed to one included study that also measured aspiration and pneumonia risk tied to opioid medications, which slow gut motility, as a check on their method [1]. That analysis found a risk ratio of 2.68, with a confidence interval of 1.89 to 3.81, suggesting the approach could detect added risk from a drug that slows motility [1].
The concern dates to June 29, 2023, when the American Society of Anesthesiologists (ASA) recommended that patients stop GLP-1 drugs before elective procedures — one day ahead for daily formulations and one week ahead for weekly ones [1]. On October 29, 2024, the ASA reversed that guidance and said most patients should keep taking their GLP-1 drug before elective surgery [1]. The newer guidance was issued jointly with the American Gastroenterological Association, the American Society for Metabolic and Bariatric Surgery, the International Society of Perioperative Care of Patients with Obesity and the Society of American Gastrointestinal and Endoscopic Surgeons [1]. Those groups now advise that perioperative use rest on shared decision-making among the patient and the procedural, anesthesia and prescribing teams, balancing the metabolic need for the drug against individual risk [1].
The review notes that the 2023 guidance did not cite studies showing increased aspiration or pneumonia risk in GLP-1 users [1]. It lists two reasons clinicians pushed back while the old guidance was in force: withholding the drugs could harm blood sugar control before and after surgery in people with diabetes, and patients who arrived for procedures unaware of the stop requirement had them canceled at the last minute, disrupting operating room schedules [1].
About 43 percent of adults who have been told by a doctor that they have diabetes, and 22 percent of those told they are overweight or obese, have used a GLP-1 receptor agonist, according to the review [1].
Why it matters for patients
If you take a GLP-1 drug and have surgery or a scope exam scheduled, the evidence behind a "stop before your procedure" instruction has weakened. The 2023 advice was issued without studies showing higher aspiration or pneumonia risk at the time [1], and the combined estimates here point toward little or no added risk across the groups studied [1]. The review still notes these drugs delay gastric emptying, which is why the concern existed in the first place [1].
Two limits are worth knowing. Combined results describe groups of patients, not one person's risk, and results broken out by individual drug, dose or procedure type have not been reported. Under current guidance, the choice sits with the patient and the care teams [1], so what a given hospital or anesthesia practice requires can differ.
What happens next
The review was published July 10, 2025 [1]. The most recent joint guidance from the ASA and the other organizations is dated October 29, 2024 [1]. Whether those groups update their recommendations again in response to this review has not been reported.
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