INTRODUCTION: High output stomas are an important and challenging complication for patients, leading to downstream sequelae including dehydration, electrolyte imbalances, malnutrition, and dependence of parenteral nutrition. Conventional treatment for a high output stoma relies on supportive care in addition to the use of antisecretory and antimotility agents; however, these may be insufficient to resolve symptoms in a timely manner and carry side effects. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are known to slow gastrointestinal motility through the ileal brake mechanism and may be a useful adjunct in the management of a high output stoma; however, their role for this indication remains poorly characterized.
METHODS: A scoping review was conducted and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search was performed to identify peer-reviewed clinical studies evaluating the safety and efficacy of GLP-1 RAs for the management of high stoma output.
RESULTS: Three studies evaluated the use of GLP-1 RAs for high stoma output. Across these studies, generally, treatment with GLP-1 RAs were associated with clinically meaningful reduction in stoma output of up to 50%. Several studies demonstrated reduced reliance on parenteral nutrition, improvements in nutritional, and anthropometric indices. Adverse effects were predominantly mild gastrointestinal symptoms, most commonly nausea, with no serious adverse events reported.
CONCLUSIONS: There is emerging evidence supporting the role of GLP1-RAs in the management of high output stomas. However, the evidence base is limited by small, heterogeneous and non-randomized studies. More robust prospective and adequately powered trials with standardized outcome measures are required to establish efficacy, safety, and long-term clinical utility.
