GLP-1 Receptor Agonists in Gastrointestinal Practices: Enhancing Both Procedural and Patient-Related Outcomes

Abstract Glucagon-like peptide-1 (GLP-1) is an incretin hormone released from gut enteroendocrine cells that modulates glucose metabolism by controlling insulin excretion and glucagon secretion and inhibits gastric emptying leading to decreased food intake, thus limiting weight gain. GLP-1 receptor agonists (GLP-1 RAs) mimic GLP-1’s effects on gastric function. In light of the promising evidence regarding the beneficial effects of GLP-1 RAs in glycemic control and weight reduction, their use in diabetic and obese patients, respectively, has increased substantially. As a result of this growth, it is essential to explore and understand the impact of these medications on gastrointestinal procedures, mainly esophagogastroduodenoscopies (EGDs) and colonoscopies. GLP-1 RAs have been shown to result in increased residual gastric contents (RGCs) in patients undergoing EGDs and poor Boston Bowel Preparation Scores (BBPSs) in those undergoing colonoscopies. This raises peri-procedural concerns regarding anesthesia and pulmonary aspiration risks, poor visibility, and the need for repeat procedures, all of which contribute to significant time, cost, and resource burden. Although the use of GLP-1 RAs prior to EGD or colonoscopy has resulted in poor outcomes in terms of poor visibility/preparation scores and the need for aborted/repeated procedures, one study showed better outcomes with concurrent EGD and colonoscopy. Interestingly, this raises important points in regard to the need to hold GLP-1 RAs prior to concurrent EGD and colonoscopy procedures and the number of days needed to hold these agents, if necessary. More research efforts are needed to develop guidelines regarding GLP-1 RA dose adjustments or discontinuations before such procedures and to improve procedural and patient-related outcomes. In the following review article, we aim at reviewing the evidence related to the impact of GLP-1 RAs, on gastrointestinal procedures, mainly EGDs and colonoscopies, and their implications on the peri-operative period.