Impact of glucagon-like peptide-1 receptor agonists on colonoscopy outcomes: a systematic review and meta-analysis

Background/Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for diabetes and obesity. Recent studies suggest they may negatively affect bowel preparation quality before colonoscopy (CLN), leading to inadequate bowel preparation (IBP) and repeat procedures. We conducted a systematic review and meta-analysis to assess this association.Methods: PubMed, Embase and Cochrane databases, along with abstracts from Digestive Disease Week 2024 and the American College of Gastroenterology Meeting 2024, were searched. Outcomes included IBP, repeat CLNs, and the mean difference in Boston Bowel Preparation Scale (BBPS) scores between GLP-1 RA users and non-users. Adjusted odds ratios (OR), for age, sex, body mass index, and diabetes, were pooled.Results: Twelve studies including 123,858 patients (57,699 GLP-1 RA users) were analyzed. GLP-1 RA use was associated with higher IBP risk (OR, 1.55; 95% CI, 1.11–2.16); adjusted analyses confirmed this (OR, 2.35; 95% CI, 2.02–2.74). BBPS scores were lower among GLP-1 RA users (mean difference, –0.68; 95% CI, –0.77 to –0.58). No association with repeat CLNs was observed (OR, 1.5; 95% CI, 0.88–2.56).Conclusions: GLP-1 RA use is linked to inadequate bowel preparation but not repeat CLNs. Further prospective studies are warranted to further evaluate this finding.