Among 49,987 patients, GLP-1 receptor agonist use is associated with increased odds of inadequate bowel preparation (odds ratio 1.23).
GLP-1 receptor agonist users have higher odds of inadequate bowel preparation compared to nonusers.
No significant differences in the detection of adenomas or sessile serrated polyps were observed.
GLP-1 receptor agonist users with diabetes showed the highest odds of inadequate preparation (odds ratio 1.88) and the lowest odds of sessile serrated polyp detection (odds ratio 0.71).
The findings suggest a need for tailored bowel preparation protocols for GLP-1 receptor agonist users, especially those with diabetes.
Simplified
INTRODUCTION: Glucagon-like peptide-1 receptor agonists () are increasingly used for managing diabetes and obesity. Although they improve glycemic control, they also delay gastrointestinal motility, potentially leading to inadequate bowel preparation for colonoscopy, which can increase the risk of missed lesions. This study aimed to evaluate the impact of GLP-1RA use on the quality of bowel preparation and on adenomas and sessile serrated polyp () detection.
METHODS: We conducted a retrospective cohort study of outpatient screening and surveillance colonoscopies at a tertiary academic medical center. Adults who used a GLP-1RA within 1 week of their colonoscopy formed the treatment group; patients not on GLP-1RA (nonusers) who never used GLP-1RA served as controls. Propensity score weighting was applied for age, sex, BMI, race, diabetes status, and relevant medications. The subgroup analysis was stratified based on diabetes status and GLP-1RA use.
RESULTS: Among 49,987 patients (4,269 GLP-1RA users, 45,718 nonusers), GLP-1RA use was associated with increased odds of inadequate bowel preparation (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.04-1.46). No significant difference in SSP and adenoma detection was observed. In subgroup analysis, GLP-1RA users with diabetes had the highest odds of inadequate preparation (OR 1.88, 95% CI 1.59-2.24) and the lowest odds of SSP detection (OR 0.71, 95% CI 0.57-0.89).
DISCUSSION: GLP-1RA use, particularly among patients with diabetes, is associated with higher odds of inadequate bowel preparation and lower SSP detection, whereas adenoma detection was unaffected. Tailored bowel-prep protocols for GLP-1RA users with diabetes should be evaluated prospectively.
Key numbers
1.23
Increase in Odds of Inadequate Bowel Preparation
Odds ratio comparing users to nonusers.
1.88
Increase in Odds of Inadequate Bowel Preparation in Diabetics
Odds ratio comparing diabetic users to nondiabetic, non- users.
5.5%
Detection Rate
Percentage of detection in users compared to 6.4% in controls.
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Guarantor of the article: Samita Garg, MD. Specific author contributions: S.G. and D.J.C.: conceptualization (Lead). S.G. and D.J.C.: methodology (Lead). S.G.: supervision (Lead); S.G.: writing – original draft (Lead); S.G., D.H., D.L., S.V., A.L., J.J.V., and D.J.C.: writing – review & editing (Lead). D.H., D.L., and Q.Y.: formal analysis (Equal). D.H. and D.L.: methodology (Equal); Q.Y.: figure creation (Lead). Q.Y.: data tables and analysis (Lead). Financial support: None to report. Potential competing interests: S.G. reports receiving an IIS grant from Abbott, a research grant with Enterra, and serving as a speaker/consultant for Novo Nordisk and Ardelyx. A.L.: is a consultant to Takeda, Ironwood, Ardelyx, Vibrant, Evoke, and Atmo, and holds stock in Johnson & Johnson, Allurion, and Bristol Myers Squibb. J.J.V.: reports serving on advisory boards for Atlas Endoscopy and Pentax Endoscopy; consulting for Olympus America, Inc., Boston Scientific, Inc., and Steris Medical, Inc.; receiving research funding from Olympus America, Inc.; and receiving patent royalties from Medtronic, Inc. The remaining authors have no relevant conflicts to declare.
