Taha Qazi, MD: Clinical Considerations for GLP-1 RA Use Before Endoscopy

The rapidly growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has prompted discussions about lesser-known side effects now coming to light with so many patients taking these medications for diabetes and obesity, and the potential for more patients to take them on-label as they are being explored for indications in hepatology for metabolic dysfunction-associated steatohepatitis (MASH).

In gastroenterology, the impact of GLP-1 RAs on gastric emptying and bowel motility has led to concerns about their interference with endoscopic procedures. The seventh issue of Qazi Corner, a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD, spotlights a review of these clinical considerations based on the current evidence and clinical guidelines. The article offers perspective on possible adverse events during endoscopy with GLP-1 RAs, other potential complications, and how these can be addressed and ideally mitigated in clinical practice.

“There's so many people using these medications… but some of the beneficial effects of these medications also result in some complications associated with their use,” Qazi explained. “In the context of endoscopy, the biggest, most interesting aspect that we are sort of realizing is that these basically delay gastric emptying, reduce bowel motility, and reduce peristalsis, which results in changes in the context of doing an endoscopy and colonoscopy that can be fairly concerning.”

Acknowledging the potential for aspiration and poor bowel preparation for such procedures when patients are using GLP-1 RAs, Qazi also mentioned how use of these medications may be associated with lower-quality colorectal cancer screening tests

“This is still being studied more extensively, but the worry is that you may not be performing the best exam and you may be putting the patient at risk for higher rates of complications in the context of aspiration or repeated procedures,” he explained, citing guideline recommendations suggesting these medications be held for a week prior to the procedure in order to minimize such risks. “I think as these medications become more ubiquitous and as we start using them more effectively, we'll find that things may change, but currently, that's the recommendation that we're utilizing in the context of these patients on GLP-1 RAs.”

Dr. David Long’s article: GLP-1 Receptor Agonists and Pre-Procedure Planning for Endoscopy