P4090 - The Impact of GLP-1 Receptor Agonists on Upper and Lower GI Endoscopy: A Systematic Review and Meta-Analysis

Spyridon Peppas, MD¹, Bara Abujaber, MD¹, Nadera Altork, MD¹, Amer Arman, MD¹, Sayel Alzraikat, MD¹, Camille Boustani, MD², Won Kyoo Cho, MD,^3
1MedStar Health-Georgetown/Washington Hospital Center, Washington, DC; ²MedStar Georgetown University Hospital, Washington, DC; ³Inova Health System/Georgetown University School of Medicine, Leesburg, VA

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are widely used oral anti-diabetic agents with increasing use for the management of obesity. Emerging literature suggests that GLP-1 RA may be associated with high gastric residue in the esophagogastroduodenoscopy (EGD) and potentially affect bowel preparation before a colonoscopy. Therefore, we aimed to investigate the influence of GLP-1 RA on the endoscopic procedures.

Methods: We performed a systematic review of the literature using Medline, Embase and Cochrane databases from inception to March 2024 to identify studies evaluating the effect of GLP-1 RA on EGD and bowel preparation for colonoscopy. We selected studies comparing gastric residue, satisfactory bowel preparation (Boston Bowel Preparation Scale, BBPS > 5) and mean BBPS scores between GLP-1 RA users versus non-users. Hedges’ g test was used to calculate the standardized mean difference of BBPS between the two groups. Random effects model was used and analysis was performed with STATA 17.

Results: Eight observational studies were included in the final analyses. The majority of the patients were diabetics. Five studies assessed the association between GLP-1 RA use and gastric residue. Overall, pooled analysis showed a higher risk for gastric retention of solid contents with GLP-1 RA use (OR: 4.35; 95% CI: 2.81-6.74, I²=0, Figure 1). Three studies reported two pulmonary aspiration events in GLP-1 RA users. Furthermore, three studies assessed the effect of GLP-1 RA use on bowel preparation before colonoscopy. No significant difference on rates of satisfactory bowel preparation was observed between GLP-1 RA users versus non-users (OR: 0.78; 95% CI: 0.36-1.71, I²=70.7%, Figure 2), while meaningless reduction of mean BBPS was seen with GLP-1 RA use (-0.28; 95% CI: -0.43 to -0.13, Figure 3). There were no data to perform separate analyses for lavage requirements, aspiration events and need for repeat EGDs and colonoscopies.

Discussion: This systematic review and meta-analysis demonstrated higher odds of gastric residue in EGD with GLP-1 use, while no effect on bowel preparation before colonoscopy was identified. However, we should highlight that the majority of the patients had diabetes which is associated with motility issues. Until we have more sufficient and robust evidence, we suggest an individual-based approach for the management of GLP-1 RA use in the pre-endoscopic settings.



Disclosures:


Spyridon Peppas, MD¹, Bara Abujaber, MD¹, Nadera Altork, MD¹, Amer Arman, MD¹, Sayel Alzraikat, MD¹, Camille Boustani, MD², Won Kyoo Cho, MD,³. P4090 - The Impact of GLP-1 Receptor Agonists on Upper and Lower GI Endoscopy: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.