Adenoma and Sessile Serrated Polyp Detection Rates in Adults Using GLP-1 Receptor Agonists

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly used for managing diabetes and obesity. While 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 aims to evaluate the impact of GLP-1RA use on the quality of bowel preparation and on adenoma and sessile serrated adenoma (SSP) polyp detection. Methods: We conducted a retrospective cohort study of outpatient screening and surveillance colonoscopies at XXX. Adults who used a GLP-1RA within one week of colonoscopy formed the treatment group; patients not on GLP-1RA (non-users) who never used GLP-1RA served as controls. Propensity score weighting was applied for age, gender, BMI, race, diabetes status, and relevant medications. The subgroup analysis was stratified based on diabetes status and GLP-1RA use. Results: Among 49,987patients (4,269 GLP-1RA users, 45,718non-users), GLP-1RA use was associated with increased odds of inadequate bowel preparation (OR 1.23, 95% 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). Conclusion: GLP-1RA use, particularly among patients with diabetes, is associated with higher odds of inadequate bowel preparation and lower SSP detection, whereas adenoma detection appear unaffected. Tailored bowel-prep protocols for GLP-1RA users with diabetes should be evaluated prospectively.