Oh YE, Kim TS, Chi SA, Park HJ, Min YW, Lee H, Lee JH, Rhee PL, Kim JJ, Min BH. Effect of glucagon-like peptide-1 receptor agonists on gastric mucosal visibility during upper endoscopy in Asian patients with diabetes. World J Diabetes 2025; 16(12): 112694 [DOI: 10.4239/wjd.v16.i12.112694]
Corresponding Author of This Article
Byung-Hoon Min, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. bhmin@skku.edu
Research Domain of This Article
Gastroenterology & Hepatology
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 15, 2025 (publication date) through Dec 15, 2025
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Publication Name
World Journal of Diabetes
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1948-9358
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Oh YE, Kim TS, Chi SA, Park HJ, Min YW, Lee H, Lee JH, Rhee PL, Kim JJ, Min BH. Effect of glucagon-like peptide-1 receptor agonists on gastric mucosal visibility during upper endoscopy in Asian patients with diabetes. World J Diabetes 2025; 16(12): 112694 [DOI: 10.4239/wjd.v16.i12.112694]
World J Diabetes. Dec 15, 2025; 16(12): 112694 Published online Dec 15, 2025. doi: 10.4239/wjd.v16.i12.112694
Effect of glucagon-like peptide-1 receptor agonists on gastric mucosal visibility during upper endoscopy in Asian patients with diabetes
Young Eun Oh, Tae-Se Kim, Sang Ah Chi, Hyun Jung Park, Yang Won Min, Hyuk Lee, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim, Byung-Hoon Min
Young Eun Oh, Tae-Se Kim, Hyun Jung Park, Yang Won Min, Hyuk Lee, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim, Byung-Hoon Min, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Sang Ah Chi, Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, South Korea
Co-first authors: Young Eun Oh and Tae-Se Kim.
Author contributions: Oh YE and Kim TS were responsible for drafting the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Oh YE, Kim TS, and Min BH were responsible for conception and design; Oh YE, Kim TS, Chi SA, and Min BH were responsible for analysis and interpretation of data; Park HJ, Min YW, Lee H, Lee JH, Rhee PL, Kim JJ, and Min BH were responsible for acquisition of data, for critical revision of the manuscript for important intellectual content; and all authors had access to the study data and reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Samsung Medical Center, approval No. 2025-02-025.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Byung-Hoon Min, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. bhmin@skku.edu
Received: August 4, 2025 Revised: September 18, 2025 Accepted: November 4, 2025 Published online: December 15, 2025 Processing time: 134 Days and 4.2 Hours
Abstract
BACKGROUND
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being used to treat type 2 diabetes mellitus (T2DM) and obesity. Although GLP-1RAs delay gastric emptying, their impact on gastric mucosal visibility during upper endoscopy remains uncertain, especially in Asian patients.
AIM
To investigate the association between GLP-1RA treatment and gastric mucosal visibility during upper endoscopy in Asian patients with T2DM.
METHODS
The study population included Korean patients who underwent esophagogastroduodenoscopy (EGD) with concomitant GLP-1RA or dipeptidyl peptidase 4 inhibitor (DPP4i) for the treatment of T2DM. A 1:2 propensity score matching between GLP-1RA and DPP4i users resulted in 198 matched patients and 295 matched patients in each group, respectively. Gastric mucosal visibility was assessed by reviewing endoscopy images with a validated scale (POLPREP). In addition, the rates of aborted and repeat EGD and pulmonary aspiration were also assessed.
RESULTS
Of the 493 matched patients, mean body mass index was 26.0 kg/m2. The rate of inadequate gastric mucosal visibility (gastric POLPREP score 0 or 1) was significantly higher in GLP-1RA group than matched DPP4i group (8.6% vs 1.4%, P = 0.0007). The rates of aborted EGD and repeat EGD were also significantly higher in GLP-1RA than DPP4i group (7.6% vs 0.7% in both aborted and repeat EGD, P = 0.0011). Multivariable logistic regression revealed GLP-1RA use as an independent risk factor for both inadequate gastric mucosal visibility (odds ratio = 6.143, 95% confidence interval: 2.289, 20.318, P = 0.0008) and aborted EGD (odds ratio = 11.099, 95% confidence interval: 3.172, 63.760, P = 0.0010). Despite gastric residue, no pulmonary aspiration was reported in either group.
CONCLUSION
GLP-1RA use was associated with a higher risk of inadequate gastric mucosal visibility and aborted and repeat procedures during upper gastrointestinal endoscopy in Korean patients with T2DM while pulmonary aspiration was not observed.
Core Tip: Korean type 2 diabetes mellitus patients with a mean body mass index of 26.0 kg/m2 treated with glucagon-like peptide-1 receptor agonists had a significantly higher rate of inadequate gastric mucosal visibility, an increased number of aborted procedures, and a significantly higher need for repeat esophagogastroduodenoscopy compared to the control group (patients treated with dipeptidyl peptidase 4 inhibitor). In addition, glucagon-like peptide-1 receptor agonist use was identified as an independent risk factor for both inadequate gastric mucosal visibility and aborted esophagogastroduodenoscopy. Despite gastric residue, pulmonary aspiration was not encountered, suggesting that increased risk of gastric content retention does not necessarily translate into higher aspiration risk.
