P4091 - Debunking Endoscopy Myths: GLP1-RA Use and GI Symptoms Do NOT Predict Bowel Preparation Success

Anshu Wadehra, MD¹, Fadi Antaki, MD², Ziad Kanaan, MD, PhD³, Samara Rifkin, MD¹, Kirthi Lilley, MD^3
1Detroit Medical Center/Wayne State University, Detroit, MI; ²John D. Dingell VA Medical Center and Wayne State University School of Medicine, Detroit, MI; ³John D. Dingell VA Medical Center, Detroit, MI

Introduction: Glucagon-like-peptide-1 receptor agonists (GLP1-RAs) are effective for managing type 2 diabetes and obesity by promoting satiety and delaying gastrointestinal motility. Concerns have arisen that GLP1-RAs may cause inadequate bowel preparation for colonoscopy. We aim to assess the rates of inadequate bowel preparation in patients on GLP1-RAs during colonoscopy and determine if peri-operative GI symptoms or GLP1-RA dose are additional risk factors.

Methods: We conducted a retrospective chart review at a single endoscopy unit. Patients who underwent colonoscopy between 2018 and 2023, on uninterrupted treatment with GLP1-RAs, were identified. Bowel preparation included a clear liquid diet for 24 hours and a split dose polyethylene glycol 3350 regimen. Patient data, including operative reports, were reviewed to assess demographics, GLP1-RA dose, peri-operative upper GI symptoms, and bowel preparation adequacy per the Boston Bowel Preparation Scale (BBPS). Adequate bowel preparation was defined as a BBPS score of ≥2 in every colon segment. These outcomes were compared to patients not on GLP1-RAs using Fisher's exact test.

Results: Ninety-eight patients on GLP1-RAs underwent colonoscopy between 2018 and 2023. The mean age was 65, with the majority being male (81%) and African American (56%). Six patients (6%) had inadequate bowel preparation requiring repeat colonoscopy, compared to a 7% inadequate prep rate (577/8267) for the entire endoscopy suite over the same time period, a non-significant difference (p=1.0). None of the six patients with inadequate prep had peri-operative GI symptoms. However, three patients with adequate prep exhibited GI symptoms prior to endoscopy (post-prandial fullness, abdominal pain, and nausea). No association was found between bowel prep adequacy and GLP1-RA dose, as four of the six patients with inadequate prep were on the lowest available dose. No adverse peri-operative events were reported.

Discussion: Our findings indicate that neither the use or dosage of GLP1-RAs, nor the presence of peri-operative GI symptoms, are associated with an inadequate bowel preparation during colonoscopy. Therefore, clinicians should not solely rely on the use of GLP1-RAs as a risk factor for inadequate bowel preparation.


Disclosures:


Anshu Wadehra, MD¹, Fadi Antaki, MD², Ziad Kanaan, MD, PhD³, Samara Rifkin, MD¹, Kirthi Lilley, MD³. P4091 - Debunking Endoscopy Myths: GLP1-RA Use and GI Symptoms Do NOT Predict Bowel Preparation Success, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.