Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study

Table 1 Association of type of gastrointestinal procedure done with gender, presence of digestive symptoms prior to endoscopy, history of cannabis use, history of opioids or methadone use, and presence of residual food

Parameter		Type of diet one day prior to the procedure		P value
		Regular diet	Clear liquid/low residue diet
Gender	Female	112	81	0.713
	Male	68	45
Nausea, vomiting, dyspepsia, bloating (digestive symptoms) prior to endoscopy	No	152	123	< 0.001
	Yes	28	3
History of cannabis use	No	165	108	0.099
	Yes	15	18
History of opioids or methadone use	No	172	118	0.461
	Yes	8	8
Presence of residual food	No	162	124	0.03
	Yes	18	2

Table 2 Impact of glucagon-like peptide-1 receptor agonist on colonoscopy preparation

Ref.	Selected population	Type of study	Patients (n)	Endpoint	Significant results
Yao et al[26]	Patients on GLP-1 RAs (cases) and patients not taking GLP-1 RAs (controls)	Retrospective cohort study	446	Comparing bowel prep quality using the BBPS between diabetic patients taking GLP-1 RAs (case group) and diabetic patients not on GLP-1 As (control group)	BBPS score of < 5 was 15.5% in the case group vs 6.6 in the control group. 18.9% of the case group needed repeat colonoscopy as compared to 11.1% in the control group
Tong et al[27]	Patients on liraglutide vs patients on sitagliptin vs patients not on GLP-1 RAs	Prospective observational study	360	Assess the incidence of inadequate bowel cleaning using the BBPS, in patients taking GLP-1 RAs vs DPP-4i vs patients not taking GLP-1 RA	No statistical significance in the incidence of inadequate bowel cleaning was found between the liraglutide group, the sitagliptin group, and the control group P = 0.927. Patients with Type 2 Diabetes and peripheral neuropathy taking GLP-1 RA did have a significant increase in inadequate bowel cleaning when compared to the sitagliptin group (61.3% vs 32.1%, P = 0.022) and control group (61.3% vs 32.8%, P = 0.025)
Sharma et al[28]	Patients aged 45-75 who had an outpatient elective colonoscopy between 2012 and 2015, took one of the following drugs–Byetta, Victoza, or Bydureon	Retrospective medical record analysis	255	Comparing bowel prep quality using high-volume polyethylene glycol electrolyte lavage solution among two groups, one taking a GLP-1 RA and other group not taking a GLP-1 RA	The percentage of satisfactory bowel preparations in the group taking a GLP-1 RA was 92.06% and 92.25% in the group not taking a GLP-1 RA

GLP-1 RAs: Glucagon-like peptide-1 receptor agonists; DPP-4i: Dipeptidyl peptidase-4-inhibitor; BBPS: Boston Bowel Preparation Scale.

Table 3 Summary of the studies assessing the impact of glucagon-like peptide-1 receptor agonists on patients undergoing esophagogastroduodenoscopy

Ref.	Selected population	Type of study	Patients (n)	Endpoint	Significant results
Stark et al[12]	Patients undergoing EGD with the use of GLP-1 RA and patients without GLP-1 RA	Retrospective cohort study with matched controls	177	Odds of retained food documented during EGD and incidence of lavage and need for repeat EGD due to poor visualization	Food retention present in 6.8% in the GLP-1 group versus 1.7% in the control group, but it was not statistically significant [OR: 4.22 (95%CI: 0.87-20.34)]. None of the patients in the study required repeat EGD due to poor visualization
Kobori et al[29]	Patients with diabetes undergoing EGD with the use of GLP-1 RA and patients without GLP-1 RA	Matched pair case-control study	410	Assess the association between GLP-RA treatment and gastric residue in patient’s undergoing EGD	The proportion of gastric residue was significantly higher in the GLP-1 RA group when compared to the group without GLP-1 RA treatment (5.4% vs 0.49%; P = 0.004)
Silveira et al[30]	Patients with diabetes undergoing EGD with the use of GLP-1 RA and patients without GLP-1 RA	Single-center retrospective electronic chart review	404	To determine if the use of GLP-1 RA is associated with delayed gastric emptying and increased residual gastric content despite adequate pre-procedure fasting before EGD	The use of Semaglutide was associated with 5.15-fold increase in residual gastric content (24% vs 5.1%; P < 0.001). The presence of digestive symptoms was associated with increased residual gastric content [3.56 (95%CI: 2.2-5.78)]
Sherwin et al[11]	Volunteers who were taking Semaglutide for weight loss and volunteers who were not on Semaglutide	Prospective observational study	20	To evaluate the presence of gastric content using gastric ultrasound in patients taking GLP-1 RA compared with controls, after 8 hours of fasting	Patients using Semaglutide had solid gastric content in 70% of the cases in the supine position as compared to 10% in control (RR: 3.50; P = 0.02). In the lateral position solid content was found in 90% of the cases vs 20% in controls (RR: 7.36; P = 0.005)

EGD: Esophagogastroduodenoscopy; GLP-1 RAs: Glucagon-like peptide 1 receptor agonists; OR: Odds ratio; RR: Relative risk.