The past decade has witnessed an increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) owing to robust evidence of its benefits in type 2 diabetes and obesity. However, delay gastric emptying effect of GLP-1RAs has raised concerns for risk of gastric food retention and pneumonia aspiration during upper endoscopy. There have been observation studies reporting an increased incidence of gastric food retention among patients on GLP-1RAs, especially long-acting one like semaglutide. But the association between GLP-1RAs use and pneumonia aspiration during EGD remains unclear due to lack of high-level evidence. We report a case of pulmonary aspiration during EGD in a patient prescribed semaglutide.