Bowel Preparation Quality in Patients Using Glucagon-Like Peptide-1 Agonists: A Systematic Review and Meta-Analysis.

Background And Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now the mainstay treatment for many chronic conditions including diabetes mellitus, obesity, heart failure and chronic kidney disease. GLP-1 RAs may affect bowel preparation for a colonoscopy by modifying intestinal motility and gastric emptying. We conducted a systematic review and meta-analysis to investigate the impact of GLP-1 RA use on bowel preparation quality, measured by the Boston Bowel Preparation Scale (BBPS), and the frequency of inadequate preparation events.

Methods: Multiple databases were searched for studies investigating the impact of GLP-1 RA on bowel preparation for colonoscopy. Primary end points included bowel preparation quality, measured by the Boston Bowel Preparation Scale (BBPS), and the frequency of inadequate preparation events. Random-effects model was used for statistical analysis.

Results: Six studies were included in the final meta-analysis. There was no significant difference in the pooled rate of inadequate bowel preparation events between the GLP-1 RA group and the control group (OR 1.00, 95% CI: 0.73-1.37, P = 0.99, I = 33%). Mean BBPS score reported in three studies was significantly lower in the GLP-1 RA group (mean difference -0.36, 95% CI: -0.44 to -0.28, P < 0.001, I = 91%).

Conclusion: GLP-1 RA use does not impact bowel preparation for colonoscopy as evident by our study. We do not recommend discontinuing GLP-1 RAs before colonoscopy. More evidence is needed to confirm the current findings.