Bowel preparation quality in patients using glucagon-like peptide-1 agonists: a systematic review and meta-analysis

Aug 22, 2025Gastrointestinal endoscopy

Bowel cleaning quality in patients using diabetes drugs called GLP-1 agonists: a review and combined analysis

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Abstract

Mean bowel preparation quality score was significantly lower by 0.36 in patients using GLP-1 receptor agonists compared to controls.

No significant difference was found in the rate of inadequate bowel preparation events between those using GLP-1 receptor agonists and the control group.
The odds ratio for inadequate preparation events was 1.00, indicating no increased risk associated with GLP-1 RA use.
The mean Boston Bowel Preparation Scale score in the GLP-1 RA group was negatively impacted, suggesting poorer bowel preparation quality.
The findings indicate that GLP-1 RA use may not affect overall bowel preparation for colonoscopy.
Discontinuation of GLP-1 RAs prior to colonoscopy is not recommended based on the current evidence.

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BACKGROUND AND AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now the mainstay treatment for many chronic conditions, including diabetes mellitus, obesity, heart failure, and chronic kidney disease. GLP-1 RAs may affect bowel preparation for a colonoscopy by modifying intestinal motility and gastric emptying. We conducted a systematic review and meta-analysis to investigate the impact of GLP-1 RA use on bowel preparation quality, measured by the Boston Bowel Preparation Scale, and the frequency of inadequate preparation events.

METHODS: Multiple databases were searched for studies investigating the impact of GLP-1 RA on bowel preparation for colonoscopy. Primary end points included bowel preparation quality, measured by the Boston Bowel Preparation Scale (BBPS), and the frequency of inadequate preparation events. Random-effects model was used for statistical analysis.

RESULTS: Six studies were included in the final meta-analysis. There was no significant difference in the pooled rate of inadequate bowel preparation events between the GLP-1 RA group and the control group (odds ratio, 1.00; 95% CI, 0.73-1.37; P = .99; I= 33%). Mean BBPS score reported in 3 studies was significantly lower in the GLP-1 RA group (mean difference, -0.36; 95% CI, 0.44 to -0.28; P < .001; I= 91%). 2 2

CONCLUSIONS: GLP-1 RA use does not impact bowel preparation for colonoscopy as evident by our study. We do not recommend discontinuing GLP-1 RAs before colonoscopy. More evidence is needed to confirm the current findings.

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Bowel preparation quality in patients using glucagon-like peptide-1 agonists: a systematic review and meta-analysis

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