Journal of clinical gastroenterology
October 1, 2026 · via Europe PMC
The Impact of Glucagon-Like Peptide 1 Receptor Agonists Versus Diabetes Mellitus on Endoscopic Procedures: A Case-Control Study From a Large Tertiary Care Health System.
Bahdi F, Bahdi F, Bachu VS, +8 more, Muthusamy VR.
AI summary — for doctors, generated from the abstract only
In a case-control study, patients on GLP-1 receptor agonists had a significantly higher rate of gastric food retention during endoscopy than matched diabetics not on these drugs, but not higher rates of inadequate bowel preparation, and a 24-hour liquid diet combined with bowel prep appeared to offset this risk when colonoscopy was also performed.
What was studied
A retrospective case-control study at a large tertiary health system comparing endoscopic procedure outcomes in patients taking GLP-1 receptor agonists (GLP1-RAs) who never held the medication before their procedure, versus matched diabetic patients not on GLP1-RAs, who underwent outpatient upper endoscopy (EGD) and/or colonoscopy between January 2018 and June 2023, assessing rates of gastric food retention (GFR) and inadequate bowel preparation (IBP).
Key findings
- Among 417 EGDs (212 cases, 205 controls) and 637 colonoscopies (303 cases, 334 controls), with no significant baseline differences in age, gender, BMI, or preprocedural A1c between groups, gastric food retention was significantly higher in GLP1-RA patients compared with controls (4.7% vs 1%, p=0.03).
- There was no difference in inadequate bowel preparation rates between groups (16.5% vs 16.5%, p=1), and no significant difference in procedure abortion rates for either EGD (1.9% vs 0.5%) or colonoscopy (7.6% vs 6%); no patients in either group experienced periprocedural aspiration or needed conversion to general anesthesia.
- Among GLP1-RA patients, those who underwent a concomitant colonoscopy (with the accompanying bowel prep and liquid diet) had a significantly lower risk of gastric food retention (0%) compared with those who underwent EGD alone (9.5%).
Clinical relevance
The findings suggest that GLP-1 receptor agonists independently increase the risk of gastric food retention during upper endoscopy beyond what diabetes alone explains, but that this absolute risk is low and a 24-hour preprocedural liquid diet combined with bowel preparation (as used for colonoscopy) appears to effectively mitigate this risk, which may inform pre-endoscopy preparation protocols for patients on these increasingly common medications.
Who should care
Limitations
This was a retrospective case-control study, which cannot fully exclude residual confounding, and the findings come from a single large health system, which may limit generalizability.
GLP-1 receptor agonists increased the risk of gastric food retention during endoscopy beyond diabetes alone, but overall procedural risks were minimal, and a 24-hour liquid diet plus bowel prep appeared to offset this risk.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
While glucagon-like peptide 1 receptor agonists (GLP1-RAs) increase the risk of gastric food retention (GFR) and inadequate bowel preparation (IBP), the confounding role of diabetes mellitus is still questioned. Here, we compare the outcomes of endoscopic procedures in patients on GLP1-RAs versus matched diabetics off GLP1-RAs, while also assessing the role of a 24-hour preprocedural liquid diet and bowel preparation in mitigating this risk.
Methods
A retrospective case-control study of patients 18 years or older on GLP1-RAs versus matched diabetics off GLP1-RAs who underwent outpatient EGD and/or colonoscopy between January 2018 and June 2023. The case group never held their GLP1-RAs. Primary outcomes were the risk of GFR and IBP. Secondary outcomes included the rates of aborted procedures, periprocedural aspiration, and the risk of GFR in GLP1-RAs who underwent EGD alone versus EGD + colonoscopy.
Results
Our study included 417 EGDs (212 cases vs. 205 controls) and 637 colonoscopies (303 cases vs. 334 controls). There was no significant difference in age, gender, BMI, and preprocedural A1c% between groups. The GFR was significantly higher in the cases compared with controls (4.7% vs. 1%, P =0.03), whereas there was no difference in IBP (16.5% vs. 16.5%, P =1). There was no significant difference in EGD abortion (1.9% vs. 0.5%, P =0.3) or colonoscopy abortion (7.6% vs. 6%, P =0.4) between cases and controls. None of the patients in both groups had periprocedural aspiration or conversion to general anesthesia. Compared with EGD alone (n=105), cases who underwent a concomitant colonoscopy (n=107) had a significantly lower risk of GFR (9.5% vs. 0%, P <0.01).
Discussion
GLP1-RAs increase the risk of GFR independent of concomitant diabetes but not the rate of IBP. The absolute procedural risks associated with GLP1-RAs are minimal. A 24-hour liquid diet combined with bowel preparation appears to offset the risk of GFR associated with GLP1-RAs.
DOI
10.1097/mcg.0000000000002414
PMID
42348290
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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