P3542 - The Role of GLP-1 Agonist in Acute Cholecystitis After a Routine Colonoscopy: A Case Report

Ahmad Mohammad Abdulraheem, MD¹, Usman Afzal, MD², Dania Qarkash, MD³, Nadera Altork, MD¹, Mohammed Abu-Rumaileh, MD⁴, Alireza Meighani, MD^5
1MedStar Health-Georgetown/Washington Hospital Center, Washington, DC; ²Washington Hospital Center, Washington, DC; ³University of Jordan School of Medicine, Washington, DC; ⁴University of Toledo, Toledo, OH; ⁵MedStar Health, Washington Hospital Center, Washington, DC

Introduction: Colonoscopy (CLN) is a commonly performed low-risk gastroenterology procedure for diagnostic and therapeutic interventions, rarely resulting in serious complications. However, patients presenting with abdominal pain and vomiting after a CLN require detailed investigation to rule out acute abdomen emergencies such as bowel perforation, splenic rupture, or bleeding(1) . Acute cholecystitis (AC) is a rarely reported post-procedural complication(2) . Multiple theories have been proposed to explain this, although the mechanism remains unknown, such presentations can occur within the first 48-72 hours.

Case Description/Methods: A 66-year-old female with obesity, on semaglutide (Wegovy) 2.4 mg weekly, presented with abdominal pain one day after a screening CLN with rectal biopsies due to a small white patch. She had withheld her semaglutide dose one week prior due to its potential to cause delayed gastric emptying. Labs showed leukocytosis with a neutrophilic shift and unremarkable liver function tests and urine analysis. A CT abdomen with contrast indicated mild intrahepatic biliary ductal dilatation, a distended gallbladder, gallstones, and extensive pericholecystic fat stranding, suggestive of AC. An abdominal ultrasound showed no CBD dilatation: 0.6cm, however, confirmed a moderately distended gallbladder with stones, sludge, diffuse wall edema, trace pericholecystic fluid(Figure-1), and a positive sonographic Murphy sign. She was started on IV broad-spectrum antibiotics, consulted general surgery for AC, and underwent a cholecystectomy.

Discussion: In a systematic review and meta-analysis of randomized controlled trials(3), the findings indicated an elevated risk of gallbladder or biliary diseases associated with GLP-1 agonist use, especially at higher doses, for extended durations, and for weight loss purposes (He et al.). The proposed mechanism involves GLP-1 agonists inhibiting gallbladder motility and delaying gallbladder emptying through a direct effect on cholecystokinin inhibition (He et al.). Although our patient ceased taking semaglutide one week before the procedure, she still developed AC.

Conclusion: This suggests that while AC after a CLN is typically rare, its occurrence might be heightened by recent GLP-1 agonist use, particularly semaglutide due to its one-week half-life. Future studies are necessary to determine the optimal washout period for these medications before colonoscopies to minimize the risk of acute cholecystitis following these procedures.



Disclosures:


Ahmad Mohammad Abdulraheem, MD¹, Usman Afzal, MD², Dania Qarkash, MD³, Nadera Altork, MD¹, Mohammed Abu-Rumaileh, MD⁴, Alireza Meighani, MD⁵. P3542 - The Role of GLP-1 Agonist in Acute Cholecystitis After a Routine Colonoscopy: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.