GLP-1RAs lower quality of bowel preparation and increase need for repeat colonoscopy

To rule out colon cancer screening, the meticulousness of bowel preparation is imperative. A recent retrospective cohort study published in The American Journal of Gastroenterology from a major academic medical center suggests that Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) use, common in obesity and diabetes management, may be associated with a reduced quality of bowel preparation.

The study led by Rebecca Yao and team focused into data from patients undergoing screening or surveillance colonoscopies from December 2021 to December 2022. The study involved 265 cases on GLP-1RAs for diabetes or obesity and 181 controls with a history of GLP-1RA use but not within three months of the procedure. 

Results showed no baseline differences between the groups except for a higher prevalence of diabetes in cases. Controlling for diabetes, the Mean Boston Bowel Preparation Scale (BBPS) was significantly higher in controls (7.0 ± 1.9 vs. 7.5 ± 2.4, p = 0.046). Cases had a notably higher percentage of patients with a total BBPS score of <5 (15.5% vs. 6.6%, p = 0.01), indicating suboptimal preparation. Moreover, the need for a repeat colonoscopy due to poor bowel prep was significantly higher in cases (18.9% vs. 11.1%, p = 0.041).

These findings underscore the potential impact of GLP-1RAs on the quality of bowel preparation, with a concerning correlation to the need for repeat colonoscopies. As inadequate bowel prep can compromise the diagnostic accuracy and therapeutic safety of colonoscopies, these results raise important considerations for individuals on GLP-1RAs slated for colon cancer screening.

Further exploration is needed to understand the cumulative effects of medications affecting gastric emptying on bowel preparation quality. This study emphasizes the need for tailored approaches based on patients' medication profiles. As research unfolds, these insights may pave the way for refinements in screening protocols to ensure optimal diagnostic accuracy and patient safety.

Source:

Yao, R., Gala, K. S., Ghusn, W., Abboud, D. M., Wallace, F. K., & Vargas, E. J. (2023). Effect of glucagon-Like Peptide-1 Receptor Agonists on bowel preparation for colonoscopy. The American Journal of Gastroenterology. https://doi.org/10.14309/ajg.0000000000002564