GLP-1s & colonoscopy bowel prep

March 25, 2025

Issue 06

Clinical Question

Do GLP-1 agonists impact colonoscopy bowel preparation?

Editor’s Bottom Line

Use of GLP-1 agonists may interfere with bowel preparation for colonoscopy. Patients who use these medications should be made aware of this and may benefit from different approaches.

Reference

Beran A, Nayfeh T, Akhras A, et al. Effect of Glucagon-Like Peptide-1 Receptor Agonists on Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis. Am J Gastroenterol. Epub ahead of print Feb 12, 2025; https://journals.lww.com/ajg/abstract.aspx

Synopsis

This systematic review and meta-analysis included five studies examining the effects of glucagon-like peptide (GLP)-1 receptor agonists on bowel preparation quality for colonoscopy. The studies were conducted between 2016 and 2023 and included four randomized controlled trials and one placebo-controlled trial. The studies included 5,434 users of GLP-1 receptor agonists and 5,399 individuals who were not using these medications.

The mean age of participants varied across studies, with most individuals falling around 55–65 years of age. Average body mass index (BMI) for the studies ranged from 23.8 to 35.6. Common comorbidities included type 2 diabetes mellitus, obesity and cardiovascular disease. The proportion of individuals with diabetes was higher in the GLP-1 receptor agonist group compared to the control group.

The analysis showed that participants using GLP-1 receptor agonists had a higher rate of inadequate bowel preparation, compared to those not using these medications (10.6% vs. 4.6%). The pooled odds ratio for inadequate bowel preparation was 2.10 (95% Confidence Interval [CI]: 1.41–3.13; p=0.0003). The mean Boston Bowel Preparation Scale score was lower among users of GLP-1 receptor agonists (mean difference = -0.34; 95% CI, -0.51 to -0.17; p=0.0001).

In a subgroup analysis of participants with diabetes, the odds ratio for inadequate bowel preparation was 1.89 (95% CI: 1.20–2.98; p=0.01). Sensitivity analyses showed consistent results when individual studies were excluded and no significant publication bias was detected.

Details

Study Design: Systematic review and meta-analysis
Funding: Not stated
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 1a