Effects of glucagon-like peptide-1 receptor agonists on endoscopy outcomes: A systematic review & meta-analysis

Background and aims: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are known to cause delayed gastric emptying, however the effect on clinical outcomes during upper endoscopy/colonoscopy remains unclear. We conducted a meta-analysis to reconcile the data.

Methods: Online databases were searched for studies evaluating GLP-1RAs vs control group (no GLP-1RAs) in patients undergoing endoscopy. The outcomes of interest were rate of retained gastric contents (RGC), aborted procedures, aspiration events and subjective bowel preparation quality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model.

Results: A total of 23 studies with 77,271 patients (4,449 in the GLP-1 RA arm and 72,703 in the control arm) were included. The mean age ranged from 47.6 to 72 years and 58.4% were females. As compared to the control group, the GLP-1 RA group had higher odds of RGC (OR 15.39, 95% CI 4.65-50.99, p < 0.01) and aborted procedures (OR 13.86, 95% CI 4.42-43.43, p < 0.01). No significant differences were observed between the two groups in terms of aspiration events (OR 21.06, 95% CI 0.13-3379.01, p=0.24) and subjective bowel preparation quality (OR 0.94, 95% CI 0.67-1.31, p=0.83).

Conclusion: While statistical significance was reached in terms of visible RGC and early termination of endoscopies in patients on GLP-1RAs, these events were overall rare. GLP-1RAs do not appear to pose significant risk, as the odds of developing aspiration were comparable in the two groups.