JAMA Intern Med

GLP-1s and endoscopy: New randomized data inform a common dilemma

March 17, 2026

The OCULUS randomized, single‑masked trial (NCT06533527), conducted at two U.S. tertiary centers, found that continuing one dose of GLP‑1 or GLP‑1/GIP agonists before elective upper endoscopy (EGD) significantly increased the risk of clinically significant residual gastric volume (RGV). Among 60 adults on stable therapy, clinically significant RGV occurred in 25% of those who continued therapy compared with 3.1% who held a single dose (absolute difference, 21.9%; 90% confidence interval [CI], 7.0%–36.7%; P=.003), prompting early trial termination for safety. In the EGD‑only subgroup, RGV rates rose to 46.7% with continuation vs. 5.0% in the holding group (absolute difference, 41.7%; 90% CI, 17.9%–65.4%; P=.001). Notably, no patients in the EGD‑plus‑colonoscopy subgroup—who consumed clear liquids the day prior—experienced significant RGV.

Clinical takeaway: Holding one dose of GLP‑1/GIP agonists before upper endoscopy substantially lowers the risk of elevated gastric contents, and clear liquids the day prior may further reduce this risk across groups.

Source:

Ahmad AI, et al. (2026, March 16). JAMA Intern Med. Holding vs Continuing GLP-1/GIP Agonists Before Upper Endoscopy: The OCULUS Randomized Clinical Trial. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2846278