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Although GLP\u20101RAs provide significant metabolic, cardiovascular, and hepatic benefits, their tendency to slow gastric emptying has raised concerns about retained gastric contents (RGC), procedural complications, and a greater risk of pulmonary aspiration during sedation or anesthesia. This review offers a translational narrative synthesis of mechanistic, physiological, and clinical evidence connecting GLP\u20101RA therapy to changes in gastric motility and peri\u2010endoscopic outcomes. Data from pharmacological studies, scintigraphic evaluations, large observational cohorts, and international consensus statements are combined to guide physiology\u2010based procedural decisions. Evidence consistently indicates that GLP\u20101RA exposure is associated with a higher incidence of RGC and more frequent procedural disruptions during upper gastrointestinal endoscopy. However, it remains uncertain whether RGC leads to clinically significant aspiration. Consistent with this, real\u2010world data reveal no increase in aspiration pneumonia among GLP\u20101RA users undergoing colonoscopy, with reported aspiration rates of approximately 0.01%\u20130.05%. Likewise, during upper gastrointestinal endoscopy, only a small absolute rise in aspiration\u2010related events has been observed, involving fewer than 0.3% of procedures. Current guidelines favor continuing GLP\u20101RA therapy alongside dietary modification, structured risk assessment, selective gastric point\u2010of\u2010care ultrasound (POCUS), and multidisciplinary communication, rather than routine cessation. Emerging prospective evidence indicates that implementing a pre\u2010procedural clear liquid diet, with individualized timing of weekly agents, may reduce the risk of clinically significant RGC, complementing existing dietary preparation strategies.<\/jats:p>","DOI":"10.1002\/cdt3.70059","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T01:26:18Z","timestamp":1781745978000},"page":"183-196","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["GLP\u20101 Receptor Agonists and Endoscopy: Understanding Gastric Stasis, Aspiration Risk, and Contemporary Peri\u2010Procedural Guidance"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1839-4330","authenticated-orcid":false,"given":"Junaid","family":"Beig","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Royal Hobart Hospital Hobart Tasmania 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