Among 1,408 participants, those using GLP-1 receptor agonists within 7 days of upper endoscopy showed no significant increase in gastric residue complications (OR 1.52, 95% CI 0.58-3.99) compared to non-users. Surprisingly, GLP-1 users had 81% lower odds of post-procedural hospitalization. This challenges current clinical practice where many physicians routinely discontinue these medications before endoscopic procedures due to delayed gastric emptying concerns. The finding carries particular weight given the predominantly African American study population—a group historically underrepresented in GLP-1 research despite higher diabetes prevalence. This represents important progress in addressing healthcare disparities in clinical evidence. However, the retrospective design and single-center setting limit generalizability. The 7-day medication window may not capture peak gastric effects of longer-acting formulations. While these results suggest routine GLP-1 discontinuation before endoscopy may be unnecessary, the reduced hospitalization rates hint at broader metabolic benefits that warrant preservation of therapy. For the millions using these medications for diabetes and weight management, this evidence supports continuing treatment without procedural interruption, though larger prospective trials across diverse populations remain essential for definitive guidelines.