S920 Clear Liquid Diet and Colonoscopy Bowel Preparation... : Official journal of the American College of Gastroenterology | ACG (2025)

Introduction:

Glucagon-like-peptide-1 receptor agonists (GLP1-RAs) have gained significant popularity due to their use in type 2 diabetes and obesity management. Concerns for safety during endoscopic and surgical procedures have been raised due to their effect on gastric motility. This study aims to assess the rate of retained gastric contents (RGC) and peri-operative complications in those on uninterrupted treatment with GLP1-RAs undergoing upper endoscopy.

Methods:

We conducted a retrospective chart review at a single endoscopy unit. Patients on GLP1-RAs who underwent EGD, with or without same-day colonoscopy, from 2018 to 2023 were identified. Patient charts and operative reports were manually reviewed to assess demographic information, dose of GLP1-RAs, presence of peri-operative upper GI symptoms, and presence of RGC on endoscopy.

Results:

Fifty-two patients on GLP1-RAs underwent EGD from 2018 to 2023. The mean age was 62, with the majority being male (71%) and White (58%). Ninety-eight percent of patients were diabetic. RGC was found in 23% (12 out of 52) of patients, with only one patient reporting pre-operative GI symptoms (abdominal pain and vomiting). There was no correlation between GLP1-RA dose and RGC. One EGD was aborted due to large RGC. No adverse events were reported. Additionally, 12 out of the 52 patients underwent same-day colonoscopy with their EGD. These patients followed a clear liquid diet for 24 hours and received a split dose polyethylene glycol 3350-electrolyte solution for bowel preparation, completed 2 hours prior to procedure. No RGC was observed during EGD in these patients. Thus, a clear liquid diet and colonoscopy preparation were significantly associated with a lower chance of RGC compared to a regular diet followed by fasting after midnight (12 out of 40 vs. 0 out of 12, Fisher’s exact test, P< 0.05).

Conclusion:

Our findings indicate GLP1-RAs are associated with high rates of RGC during EGD. The clinical significance is unclear as most procedures could be completed, and no aspiration was documented. In patients undergoing same-day colonoscopy, the absence of RGC suggests a protective effect from the clear liquid diet or bowel preparation. As a result, colonoscopy procedures should not require interruption of GLP1-RAs or changes to the pre-procedural instructions. A 24-hour clear liquid diet appears to be effective in eliminating RGC in GLP1-RA patients and should be considered as a recommendation prior to EGDs in patients taking GLP1-RAs (see Table 1).