Impact of Glucagon-like Peptide-1 Receptor Agonists on Bowel Preparation for Colonoscopy: A Large, Matched Regional Cohort

Jun 30, 2025The Annals of pharmacotherapy

How Blood Sugar Drugs Affect Colonoscopy Bowel Cleaning in a Large Regional Group

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Abstract

Use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) was associated with a 2.6 times higher odds of inadequate bowel preparation during colonoscopy.

Inadequate bowel preparation indicators were observed more frequently in patients using GLP-1RAs.
The GLP-1RA cohort had 125 cases of inadequate preparation compared to 56 in the matched cohort.
Individual components of inadequate preparation were also more common in the GLP-1RA group.
There was a higher recommendation for extended bowel preparation for future colonoscopies in the GLP-1RA cohort.
Repeat colonoscopy procedures were more prevalent among patients prescribed GLP-1RAs, with 26 cases compared to 9.

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BACKGROUND: Poor colon preparation may negatively affect colonoscopy accuracy, result in cancelation, or need for repeat procedure. The glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications delay gastric emptying, although the clinical impact of this on the quality of colon preparation is not known.

METHODS: This was a retrospective matched cohort study in a multi-center, outpatient setting. Colonoscopy reports for patients prescribed GLP-1RA at the time of procedure were compared to a cohort matched for diabetes and cirrhosis who were not prescribed GLP-1RA at the time of procedure. The primary endpoint was a composite of indicators for inadequate bowel preparation.

OBJECTIVE: The current study's objective is to analyze the effects of GLP-1RA medications on the quality of colonoscopy preparation.

RESULTS: There were 503 patients in each cohort and baseline characteristics were similar. Use of GLP-1RA at the time of colonoscopy was associated with a greater odds of the composite outcome (125 vs 56, odds ratio [OR] = 2.6; 95% CI, 1.9-3.7). There were also increased odds for individual outcome components including proceduralist documenting inadequate, suboptimal, or poor bowel preparation, narrative comments related to inadequate bowel preparation, and recommendation for extended bowel preparation with future colonoscopy. Repeat procedure was also more common in the GLP-1RA cohort (26 vs 9, OR = 3.0; 95% CI, 1.4-6.5).

CONCLUSION AND RELEVANCE: This study assessed the impact of the GLP-1RA class of medication on the quality of bowel preparation for lower endoscopies. Glucagon-like peptide-1 receptor agonist use increased the odds of inadequate bowel preparation and repeat procedure.

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Impact of Glucagon-like Peptide-1 Receptor Agonists on Bowel Preparation for Colonoscopy: A Large, Matched Regional Cohort

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