Glucagon-like peptide-1 receptor agonists significantly affect the quality of bowel preparation for colonoscopy

📖 Top 20% JournalOct 10, 2024Endoscopy

Drugs that activate GLP-1 receptors may change how well the bowel is cleaned before a colonoscopy

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Abstract

Among 4876 patients treated with GLP-1 receptor agonists, 10% had inadequate bowel preparation for colonoscopy.

Inadequate bowel preparation (IBP) was defined as either 'poor preparation' on the Aronchik scale or a Boston Bowel preparation scale score of less than 5.
The control group, consisting of 4876 patients not treated with GLP-1RAs, had an IBP rate of 4%.
Diabetic patients treated with GLP-1RAs exhibited a higher rate of IBP at 12% compared to 5% among diabetic patients not receiving GLP-1RAs.
Nondiabetic patients treated with GLP-1RAs had an IBP rate of 8%, while nondiabetic controls had a rate of 3%.
Both diabetes and GLP-1RA use were identified as independent risk factors for IBP, with odds ratios of 1.4 and 2.7, respectively.

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BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) affect gastrointestinal motility, slowing gastric emptying and colonic transit. GLP-1RAs have an impact on gastric residue before endoscopy, but only limited data are available regarding its effect on the adequacy of colonic preparation. We investigated the association between GLP-1RA use and inadequate bowel preparation (IBP) for colonoscopy.

METHODS: We performed a multicenter retrospective study with GLP-1RA cases matched with controls (using propensity scores for age, sex, diabetes mellitus [DM], obesity, and co-morbidities). Data on demographics, medication use, procedural indications, and colonoscopy findings were collected. IBP ("poor preparation" on Aronchik scale or Boston Bowel preparation scale <5) was the primary outcome.

RESULTS: 4876 patients treated with GLP-1RAs were included in the analysis and compared with 4876 controls selected from 333 648 patients without GLP-1RA use. Among the GLP-1RA patients, 10% (n = 487) had IBP compared with 197 (4%) of the control group (<0.001). Subgroup analysis showed a higher rate of IBP among diabetic patients treated with GLP-1RA (284/2364 [12%]) than among diabetic patients without GLP-1RA treatment (118/2364 [5%];<0.001). Additionally, 203/2512 nondiabetic patients treated with GLP-1RAs had IBP (8%) compared with 79 of the nondiabetic non-GLP-1RA group (3%;<0.001). On multivariate analysis, diabetes and GLP-1RA use were both found to be independent risk factors for IBP (odds ratio [OR] 1.4 and OR 2.7, respectively; both<0.001). P P P P

CONCLUSION: Our findings highlight the necessity for special attention and tailored recommendations for both diabetic and nondiabetic patients treated with GLP-1RAs in terms of colonic preparation prior to colonoscopy.

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