The Impact of Glucagon-Like Peptide 1 Receptor Agonists Versus Diabetes Mellitus on Endoscopic Procedures

OBJECTIVES: While glucagon-like peptide 1 receptor agonists (GLP1-RAs) increase the risk of gastric food retention (GFR) and inadequate bowel preparation (IBP), the confounding role of diabetes mellitus is still questioned. Here, we compare the outcomes of endoscopic procedures in patients on GLP1-RAs versus matched diabetics off GLP1-RAs, while also assessing the role of a 24-hour preprocedural liquid diet and bowel preparation in mitigating this risk. METHODS: A retrospective case-control study of patients 18 years or older on GLP1-RAs versus matched diabetics off GLP1-RAs who underwent outpatient EGD and/or colonoscopy between January 2018 and June 2023. The case group never held their GLP1-RAs. Primary outcomes were the risk of GFR and IBP. Secondary outcomes included the rates of aborted procedures, periprocedural aspiration, and the risk of GFR in GLP1-RAs who underwent EGD alone versus EGD + colonoscopy. RESULTS: Our study included 417 EGDs (212 cases vs. 205 controls) and 637 colonoscopies (303 cases vs. 334 controls). There was no significant difference in age, gender, BMI, and preprocedural A1c% between groups. The GFR was significantly higher in the cases compared with controls (4.7% vs. 1%, P=0.03), whereas there was no difference in IBP (16.5% vs. 16.5%, P=1). There was no significant difference in EGD abortion (1.9% vs. 0.5%, P=0.3) or colonoscopy abortion (7.6% vs. 6%, P=0.4) between cases and controls. None of the patients in both groups had periprocedural aspiration or conversion to general anesthesia. Compared with EGD alone (n=105), cases who underwent a concomitant colonoscopy (n=107) had a significantly lower risk of GFR (9.5% vs. 0%, P<0.01). DISCUSSION: GLP1-RAs increase the risk of GFR independent of concomitant diabetes but not the rate of IBP. The absolute procedural risks associated with GLP1-RAs are minimal. A 24-hour liquid diet combined with bowel preparation appears to offset the risk of GFR associated with GLP1-RAs.