Adenoma and Sessile Serrated Polyp Detection Rates in Adults Using Glucagon-Like Peptide-1 Receptor Agonists

Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly used for managing diabetes and obesity. Although they improve glycemic control, they also delay gastrointestinal motility, potentially leading to inadequate bowel preparation for colonoscopy, which can increase the risk of missed lesions. This study aimed to evaluate the impact of GLP-1RA use on the quality of bowel preparation and on adenomas and sessile serrated polyp (SSP) detection.

We conducted a retrospective cohort study of outpatient screening and surveillance colonoscopies at a tertiary academic medical center. Adults who used a GLP-1RA within 1 week of their colonoscopy formed the treatment group; patients not on GLP-1RA (nonusers) who never used GLP-1RA served as controls. Propensity score weighting was applied for age, sex, BMI, race, diabetes status, and relevant medications. The subgroup analysis was stratified based on diabetes status and GLP-1RA use.

Among 49,987 patients (4,269 GLP-1RA users, 45,718 nonusers), GLP-1RA use was associated with increased odds of inadequate bowel preparation (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.04-1.46). No significant difference in SSP and adenoma detection was observed. In subgroup analysis, GLP-1RA users with diabetes had the highest odds of inadequate preparation (OR 1.88, 95% CI 1.59-2.24) and the lowest odds of SSP detection (OR 0.71, 95% CI 0.57-0.89).

GLP-1RA use, particularly among patients with diabetes, is associated with higher odds of inadequate bowel preparation and lower SSP detection, whereas adenoma detection was unaffected. Tailored bowel-prep protocols for GLP-1RA users with diabetes should be evaluated prospectively.