BACKGROUND AND STUDY AIMS: Data on respiratory complications associated with GLP-1 receptor agonist (GLP-1 RA) use before endoscopic procedures are limited. PATIENTS AND METHODS: We conducted a retrospective cohort study using TriNetX in adults with diabetes or obesity on GLP-1 RAs within 3 months of endoscopy, comparing them with non-GLP-1 RA users. Propensity score matching and Cox proportional hazards models were used to assess outcomes. RESULTS: Among 46,948 patients, no significant differences in post-endoscopy aspiration pneumonitis (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.54-1.56) or pneumonia (HR 1.01, 95% CI 0.83-1.24) were found between groups. CONCLUSIONS: GLP-1 RA use before endoscopy does not increase respiratory complications, supporting continued preoperative medication use.