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
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Gastroenterology & Hepatology
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Retrospective Cohort Study
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Dec 15, 2025 (publication date) through Dec 15, 2025
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World Journal of Diabetes
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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]
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
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 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.
Citation: 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
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being used to treat type 2 diabetes mellitus (T2DM) and obesity. GLP-1RAs exert glycemic and weight- lowering effects through mechanisms that include delayed gastric emptying[1,2]. Recently, delayed gastric emptying associated with the use of GLP-1RAs has raised concerns for potential adverse effects in the periprocedural setting, including gastric content retention and pulmonary aspiration. The increase in gastric residue may preclude a thorough inspection of the gastric mucosa, resulting in a reduced diagnostic yield and the need for a repeat esophagogastroduodenoscopy (EGD). Studies examining the impact of GLP-1RAs on upper gastrointestinal (UGI) endoscopy have yielded mixed results, making it challenging to establish periprocedural guidelines[3-10].
Recently, the American Society of Anesthesiologists has issued a consensus-based statement suggesting discontinuation of GLP-1RAs on the day of the procedure for patients on daily dosing and for a week before the procedure for patients on weekly dosing[11]. In contrast, the American Gastroenterological Association has issued a rapid clinical practice update advocating for individualized decision-making regarding GLP-1RA management in the pre-endoscopic setting. The American Gastroenterological Association claims that drug cessation in patients relying on GLP-1RA for diabetes management might result in more risks than benefits[12].
To date, few studies have evaluated the effect of GLP-1RA treatment on UGI endoscopy in Asian patients whose body mass index (BMI) generally tends to be lower than that in Western populations[13]. Recent Western studies on the impact of GLP-1RAs on UGI endoscopy reported that high BMI was significantly associated with poor gastric mucosal visibility and an increased risk of aborted procedures[6,8,14]. Alkabbani et al[6] reported that GLP-1RA group had a higher risk of aborted EGD compared to the control group only among those with a BMI ≥ 30 kg/m2 and not among those with a BMI < 30 kg/m2. These results indicate the potential importance of BMI on gastric motility in patients taking GLP-1RAs and raised the need for further studies in Asian patients with lower BMI.
In the present study, we aimed to investigate the effect of GLP-1RA treatment on gastric content retention and mucosal visibility during upper endoscopy in Asian patients with T2DM. A validated scale (POLPREP) was used to objectively assess gastric mucosal cleanliness and visibility during EGD[8,15,16].
MATERIALS AND METHODS
Study design and patients
We conducted a single-center retrospective case-control study with a propensity score-matched analysis in adults undergoing EGD with or without concomitant treatment with GLP-1RAs at Samsung Medical Center from January 2014 through August 2024. Korean patients with T2DM who were older than 18 years and underwent EGD with concomitant treatment with GLP-1RA (e.g., dulaglutide, liraglutide, or lixisenatide) or dipeptidyl peptidase 4 inhibitor (DPP4i) were eligible for inclusion. We used patients taking DPP4i (e.g., linagliptin, vidagliptin, or gemigliptin) as a control group, as DPP4i is a common medication class used to treat T2DM with a mechanism of action somewhat similar to that of GLP-1RAs, but with negligible effects on gastric emptying[7,17]. In addition, recent Korean and American guidelines state that DPP4is and GLP1-RAs should not be combined, which might contribute to minimizing errors in classifying case and control groups[18,19]. Exclusion criteria were: A history of UGI, altered UGI tract anatomy, concurrent colonoscopies, incomplete prescription record for GLP-1RA or DPP4i at the time of EGD, incomplete data, inpatient setting, and active gastrointestinal hemorrhage. After exclusion, 733 patients qualified for the analysis (Figure 1). All enrolled patients started fasting from midnight and therefore all EGD procedures were performed with a preprocedural fasting period of at least 8 hours. This study was approved by the Institutional Review Board of Samsung Medical Center, approval No. 2025-02-025; February 19, 2025. Written informed consent was waived by the Institutional Review Board considering the retrospective nature of the study. This research was conducted in accordance with the guidelines of the Declaration of Helsinki.
Figure 1 Flow diagram describing identification of cases and propensity-matched controls.
EGD: Esophagogastroduodenoscopy; GLP-1RA: Glucagon-like peptide-1 receptor agonist; T2DM: Type 2 diabetes mellitus; DPP4: Dipeptidyl peptidase 4; DPP4i: Dipeptidyl peptidase 4 inhibitor; UGI: Upper gastrointestinal; BMI: Body mass index; DM: Diabetes mellitus; HbA1c: Hemoglobin A1c.
Variables and definitions
Patients with T2DM who underwent EGD and were being treated with GLP-1RAs or DPP4i surrounding the EGD were identified. They were further selected according to the inclusion and exclusion criteria through the Clinical Data Warehouse tool of Samsung Medical Center and review of their electronic medical records. The data collected included demographic characteristics such as BMI, complications associated with T2DM (e.g., diabetic retinopathy, diabetic neuropathy, diabetic nephropathy), comorbidities, medication history (insulin and gastric modulators including opiates, tricyclic antidepressants, anticholinergic agents, and prokinetic agents) and preprocedural metrics. In all patients, hemoglobin A1c (HbA1c) measurement was done within three months of EGD. Among comorbidities, low estimated glomerular filtration rate (eGFR) was diagnosed if eGFR was less than 60 mL/minute/1.73 m2 at the time of EGD[20]. The eGFR was calculated using the new equation provided by the Chronic Kidney Disease Epidemiology Collaboration[21]. EGD reports and recorded EGD images were retrospectively reviewed and assessed by blinded expert gastroenterologists using the validated POLPREP scale. The POLPREP scale is a 4-point numerical scale that assesses mucosal cleanliness and scores gastric mucosal visibility during EGD. Scores range from 0 to 3 (0: Completely obscured; 1: Poor visibility; 2: Good visibility; 3: Excellent visibility). According to the previous study with prospective validation, adequate cleanliness in stomach was defined if the score was 2 or 3[8,15,16]. Gastric residue was defined as the presence of any solids in the stomach not amenable to clearance with suction through the endoscope.
Outcomes
The primary outcome was gastric mucosal visibility assessed by the POLPREP scale, where inadequate gastric mucosal visibility was defined as gastric POLPREP score 0 or 1. Secondary outcomes included aborted procedures due to inadequate visibility, the need for a repeat EGD, and pulmonary aspiration. EGD procedure was aborted according to the endoscopist’s discretion when gastric content retention precluded a thorough inspection of the gastric mucosa.
Statistical analysis
The statistical methods of this study were reviewed by Sang Ah Chi from Samsung Medical Center. Prior to matching, differences between groups (GLP-1RAs vs DPP4i) were evaluated using Student’s t-test or the Wilcoxon rank-sum test for continuous variables and χ2 or Fisher’s exact test for categorical variables. To address differences in confounding patient characteristics that could potentially influence gastric emptying rates and mucosal visibility between patients who were treated with GLP-1RAs vs DPP4i, propensity score matching analysis was conducted. Propensity scores were calculated through logistic regression analysis incorporating variables that showed significant difference in group comparisons (age, BMI, HbA1c, insulin use, low eGFR) as well as clinically relevant variables (sex, complications associated with T2DM). A 1:2 propensity score-matched cohort was constructed using the nearest neighbor matching method without replacement using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity scores[22]. Matching was considered balanced when the absolute standardized mean difference was less than 0.2[23].
After matching, univariable logistic regression analyses with the generalized estimating equation method were performed in propensity-matched patients to investigate whether any variables were correlated to outcomes of procedure. Factors with P values less than 0.1 in univariable analyses were considered in multivariate logistic regression analyses to further investigate the independent risk factors associated with outcomes of the procedure. Analyses were performed with R 4.2.2 (Vienna, Austria; http://www.R-project.org/).
RESULTS
Clinical characteristics
The characteristics of the study population before and after propensity score matching are summarized in Table 1. Before matching (n = 733), there were significant differences between patients treated with GLP-1RA and DPP4i in age, BMI, HbA1c, frequency of insulin use, and frequency of low eGFR. In GLP-1RA group, 79.8% (166/208) of subjects used subcutaneous dulaglutide and remaining 20.2% (42/208) of subjects used subcutaneous liraglutide or lixisenatide. After 1:2 propensity score matching, 198 and 295 patients treated with GLP-1RA and DPP4i were selected, respectively (Figure 1), and all variables were well balanced between two groups. Of the 493 matched patients, the mean age was 62.1 years and mean BMI was 26.0 kg/m2.
Table 1 Characteristics of glucagon-like peptide-1 receptor agonist users and dipeptidyl peptidase 4 inhibitor users before and after matching, n (%).
Of the 493 matched patients, 4.3% showed inadequate gastric mucosal visibility assessed by the POLPREP scale, and 3.4% had aborted EGD and consequently underwent repeat EGD (Table 2). The rate of inadequate gastric mucosal visibility (gastric POLPREP score 0 or 1) was significantly higher in the GLP-1RA group than matched DPP4i group (8.6% vs 1.4%). The rates of aborted EGD and repeat EGD were also significantly higher in the GLP-1RA than DPP4i group (7.6% vs 0.7% in both aborted and repeat EGDs). Despite the presence of gastric residue in these patients, no pulmonary aspiration was reported in either group.
Table 2 Procedural outcomes of glucagon-like peptide-1 receptor agonist users and dipeptidyl peptidase 4 inhibitor users before and after matching, n (%).
Risk factors for inadequate gastric mucosal visibility and aborted EGD
Table 3 shows the results of univariate and multivariate logistic regression analyses to evaluate risk factors for inadequate gastric mucosal visibility. These analyses revealed treatment with GLP-1RA [odds ratio (OR) = 6.143; 95% confidence interval (CI): 2.289-20.318] as the only independent risk factor for inadequate gastric mucosal visibility. In subgroup analysis, ORs for dulaglutide group and liraglutide or lixisenatide group were 6.646 (95%CI: 2.381-22.487, P = 0.0007) and 4.887 (95%CI: 0.940-22.132, P = 0.0405), respectively.
Table 3 Multivariate analysis of risk factors for inadequate gastric mucosal visibility.
Table 4 demonstrates the results of univariate and multivariate logistic regression analyses to assess risk factors for aborted EGD. These analyses found that treatment with GLP-1RA use (OR = 11.099; 95%CI: 3.172-63.760) and low eGFR (OR = 4.137; 95%CI: 1.153-12.992) were independent risk factors for aborted EGD. In subgroup analysis, ORs for dulaglutide group and liraglutide or lixisenatide group were 9.438 (95%CI: 2.612-34.097, P = 0.0006) and 8.422 (95%CI: 1.739-40.789, P = 0.0081), respectively.
Table 4 Multivariate analysis of risk factors for aborted esophagogastroduodenoscopy.
Gastric emptying delay associated with GLP-1RA use has raised concerns for potential adverse effects during EGD, including gastric content retention and pulmonary aspiration[1,2]. Mechanistically, GLP1-RAs imitate incretins. These hormones are released after feeding and trigger glucose-dependent insulin release from pancreatic islet cells. The incretin effect also blocks glucagon release, activates satiety centers, and delays gastric emptying. By impairing gastric motility, GLP-1RAs promote intragastric residue, such as foam, opaque fluid, or solid remnants, which may obscure mucosal visualization during endoscopy. To date, studies examining the impact of GLP-1RAs on UGI endoscopy have yielded mixed findings on the association between GLP-1RA use and periprocedural adverse effects. In two US studies, treatment with GLP-1RA did not significantly increase the odds of gastric content retention or repeat EGD[3,4]. Ethnicity and BMI may affect gastric motility in patients taking GLP-1RAs[6,8,14]. However, most previous studies were based on data from Western population. To date, few studies have evaluated the effect of GLP-1RA treatment on UGI endoscopy in Asian patients whose BMI tends to be lower than that in Western populations[13]. In previous Western studies, mean BMI of patients treated with GLP-1RA ranged from 32.9 kg/m2 to 40.7 kg/m2[3,4,8-10,14].
The present study included a large population of Korean patients with T2DM with a mean BMI of 26.0 kg/m2. We found that Korean patients treated with GLP-1RAs had a significantly higher rate of inadequate gastric mucosal visibility, an increased number of aborted procedures, and a higher need for repeat EGD. These findings were consistent with the results from recent meta-analyses mainly based on Western studies[24-26]. In addition, GLP-1RA use was identified as an independent risk factor for both inadequate gastric mucosal visibility and aborted EGD. To the best of our knowledge, this is the first Asian study addressing these issues including risk factor analyses.
In the present study, we used a validated scale, POLPREP to score gastric mucosal visibility. This enabled us to objectively assess the quality of preparation and quantification of retained gastric contents during EGD. In a United States study by Chapman et al[8], the rates of inadequate gastric mucosal visibility (gastric POLPREP score 0 or 1) were significantly higher in the GLP-1RA group than the matched control group (20.2% vs 8.4%). These findings align with the present study, demonstrating that GLP-1RA use increased the odds of gastric content retention. However, the rates of both groups in United States patients were numerically higher than those in our study (8.6% vs 1.4%). A much higher mean BMI of 36.0 kg/m² in United States patients might account for this discrepancy. In fact, Chapman et al[8] reported that high BMI was significantly associated with a lower visibility score in logistic regression analysis. Other Western studies also reported the potential importance of BMI on gastric motility in patients taking GLP-1RAs. Alkabbani et al[6] reported that GLP-1RA group had a higher risk of aborted EGD compared to the control group only among those with a BMI ≥ 30 kg/m2. Among those with a BMI < 30 kg/m2, the risk of aborted EGD was comparable between two groups.
In the present study with patients with a mean BMI of 26.0 kg/m2, a high BMI showed borderline significance as an independent risk factor for aborted EGD. In addition, low eGFR was also identified as an independent risk factor for aborted EGD. Previous studies reported that low eGFR can significantly impact gastric motility, leading to delayed gastric emptying due to uremic toxins, electrolyte imbalances, and altered GI hormones[27,28]. A Japanese study by Kobori et al[13], showing significantly higher gastric residue in the GLP-1RA group compared to the control group (5.4% vs 0.49%), included only four variables (age, sex, HbA1c, and insulin treatment) in their analysis and did not report other clinically relevant variables, including BMI and renal function. Given these results and paucity of Asian data, further research is crucial to understand the true impact of GLP-1RA treatment on upper endoscopy in Asian patients with a different BMI distribution relative to Western patients.
Although GLP-1RA group in the present study more frequently underwent gastric content retention, aborted procedures, and repeated EGD than matched DPP4i group, no pulmonary aspiration occurred in either GLP-1RA or DPP4i group. In three United States retrospective cohort studies based on claim data, risk of aspiration pneumonia during EGD among patients treated with GLP-1RA ranged from 0.07% to 0.83%[5-7]. Our large study with no aspiration episodes further indicates the relatively low risk of pulmonary adverse events associated with GLP-1RA use. This is also supported by recent meta-analyses consistently reporting comparable aspiration rates between GLP-1RA and control groups[24-26]. These results suggest that although GLP-1RA use increases the risk of gastric content retention, they do not necessarily translate to an increased risk of aspiration pneumonia. Despite this relatively low risk of aspiration pneumonia associated with GLP-1RA use, the American Society of Gastrointestinal Endoscopy position statement recently suggests a liquid diet 24 hours before all endoscopic procedures and holding GLP-1RAs before elective endoscopy procedures for patients on GLP-1RAs[29]. As the benefits of glycemic control must be weighed against the risks of delayed gastric emptying and the associated adverse effects when using GLP-1RAs, further research is required to establish a balanced preprocedural strategy.
There are several limitations that need to be mentioned. First, this was a single-center retrospective study and EGD reports and recorded EGD images were retrospectively reviewed. Therefore, inherent limitations of retrospective data cannot be avoided and the possibility of potential bias could not be excluded. Second, as the study was performed in a tertiary care setting and only included outpatients, our findings may not be generalizable to the primary care setting or to the inpatients with complex comorbidities. Third, risk of aspiration pneumonia during EGD among United States patients treated with GLP-1RA ranged from 0.07% to 0.83%[5-7], which implies the need for very large cohort to detect the occurrence of pulmonary complications. Although our study population included 733 subjects, this number might be still insufficient to experience the occurrence of pulmonary aspiration. Fourth, newer, more potent GLP1-RAs such as semaglutide or tirzepatide were not included in the analysis as these drugs were commercially available in Korea only after October 2024. We also excluded GLP1-RA use exclusively for weight loss to minimize between-group variability by focusing on patients with T2DM. Despite these limitations, our study offers valuable insights and advances the understanding on the impact of GLP-1RAs on UGI endoscopy in Asian patients. The study’s strengths include a large sample size, using a validated scale to objectively score gastric mucosal visibility, and performing propensity score matching analysis to address confounding factors which could potentially influence procedural outcomes.
CONCLUSION
In conclusion, GLP-1RA use at the time of UGI endoscopy was associated with higher risk of inadequate gastric mucosal visibility, aborted procedures, and repeated EGD in Korean patients with T2DM, while pulmonary aspiration was not observed. Our study also revealed GLP1-RA use as an independent risk factor for adverse procedural outcomes on EGD in Korean patients with lower BMI. These results may be of important clinical relevance to optimize recommendations for EGD preparation among patients being treated with GLP1-RA. Additional evidence and prospective studies are needed in order to establish preprocedural guidelines in these patients.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Endocrinology and metabolism
Country of origin: South Korea
Peer-review report’s classification
Scientific Quality: Grade A, Grade A, Grade B, Grade B, Grade B, Grade B, Grade C
Novelty: Grade A, Grade B, Grade B, Grade C
Creativity or Innovation: Grade A, Grade B, Grade C, Grade C
Scientific Significance: Grade A, Grade A, Grade B, Grade D
P-Reviewer: Cai L, MD, PhD, Professor, United States; Giordano A, MD, PhD, Assistant Professor, Spain; Haider KH, PhD, Full Professor, Saudi Arabia; Papazafiropoulou A MD, PhD, Greece; Pappachan JM, MD, FRCP, MRCP, Professor, Senior Researcher; United Kingdom S-Editor: Bai Y L-Editor: A P-Editor: Xu ZH
Kobori T, Onishi Y, Yoshida Y, Tahara T, Kikuchi T, Kubota T, Iwamoto M, Sawada T, Kobayashi R, Fujiwara H, Kasuga M. Association of glucagon-like peptide-1 receptor agonist treatment with gastric residue in an esophagogastroduodenoscopy.J Diabetes Investig. 2023;14:767-773.
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