Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyMay 2025
In a meta-analysis, patients who took glucagon-like peptide-1 agonists were more likely to have inadequate bowel preparation.
Professional societies recommend that we hold glucagon-like peptide-1 (GLP-1) receptor agonists in selected patients prior to upper endoscopy, although we do not really know whether periprocedural use of these medications is associated with excess risk for pulmonary aspiration (NEJM JW Gen Med Dec 1 2024 and Clin Gastroenterol Hepatol 2024; Oct 29: S15423565(24)009108). Guidance on managing GLP-1 agonists before colonoscopies has been even less clear.
In this study, researchers conducted a systematic review and meta-analysis to assess the effect of GLP-1 agonists on quality of colonoscopy bowel preparation. Five studies with about 11,000 participants were included. Among patients taking GLP-1 agonists, 11% had inadequate bowel prep, compared with 5% of controls. Of note, one multicentred retrospective study accounted for 90% of the included data (Endoscopy 2025; 57: 126-133). The overall certainty of evidence was ‘low.’
Comment: Theoretically, GLP-1 agonists might hamper bowel prep quality by lowering patients’ tolerance for bowel prep protocols, by slowing colonic transit, or both. I discussed the findings of this study with several gastroenterology colleagues, most of whom said they had not noticed an association between GLP-1 agonists and inadequate bowel preparation. Nevertheless, many also said that they generally ask patients to hold these medications prior to colonoscopy. Withholding a dose of GLP-1 agonists before colonoscopy seems reasonable, as it is unlikely to cause harm, will ease concerns about aspiration, and – according to this study – might improve the likelihood of a successful procedure.
Molly S. Brett, MD, Assistant Professor of Clinical Medicine, University of Colorado School of Medicine; Primary Care Physician, Rocky Mountain Regional VA Medical Center, Aurora, USA.
Beran 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 2025 Feb 12; e-pub (https://doi.org/10.14309/ajg.0000000000003362).
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Gastroenterology, Hospital Medicine.