The reason a GLP-1 complicates a sedated procedure is simple enough: the medicine slows the stomach, and sedation removes the reflexes that keep stomach contents out of your lungs. What has been unsettled is what to do about it. A review published on 18 September pulls the recent evidence together.
What happened
The review, in Current Opinion in Gastroenterology, summarises the physiology of delayed gastric emptying on these medicines and the newer work on residual gastric volume, meaning food or fluid still sitting in the stomach when a procedure begins (PubMed 42762178).
Four findings are worth carrying.
GLP-1s delay gastric emptying through vagally mediated pathways, and with long-term use that delay is attenuated. The effect is strongest early and settles as the body adapts, which is why time on the medicine belongs in the conversation alongside the dose.
GLP-1s significantly increase the risk of residual gastric volume. That is stated plainly, and it is the reason none of this can be waved away.
Both strategies work. Holding a dose beforehand and continuing the medicine with 24 hours of clear liquids are described as effective, with a trend towards greater effectiveness for the liquid diet.
And point-of-care ultrasound, in experienced hands, is highly accurate at identifying a full stomach before sedation. A minute with a probe turns an assumption into a measurement.
Why the advice you were given may differ
The guidance moved. The first consensus advice, in 2023, was to hold the medicine for one dosing interval. In October 2024 a five-society statement reversed the default, saying most people should continue their GLP-1 before elective procedures, with a 24-hour clear liquid diet for those at highest risk.
This review lands on the same side, and adds something useful: it is not that holding a dose is wrong. It is that the two approaches are both reasonable, and the liquid diet looks slightly better while avoiding the costs of an interrupted prescription.
Those costs are real. A missed week means appetite returning, blood sugar drifting for anyone taking it for diabetes, and a restart at the old dose that the gut no longer tolerates.
What it means for you
Tell the endoscopy unit when you book, not when you arrive. They need the drug, the dose, when your last one was, whether the dose has changed recently and whether you currently have gut symptoms.
Then ask the specific question: do you want me to hold a dose, or to take clear liquids for 24 hours? Both are defensible and your team gets to choose, but the question tells them you know there is a choice.
If you are early in dose escalation or have had nausea or vomiting this week, say so without being asked. That is what moves you into the group where the precautions matter most.
What to do with this
The days around a procedure are the one time the usual advice is suspended and the fasting instructions win. The rest of the time, the job is the same.