Glucagon‐like peptide‐1 analogues in the management of high output stoma in adult patients: A narrative review

BACKGROUND: High output stoma is an adverse complication of intestinal resection in patients with an enterostomy or enterocutaneous fistula. In the absence of a defined stepwise approach and limited options for high output stoma refractory to conventional treatment, glucagon-like peptide-1 (GLP-1) analogues have emerged as a potential therapeutic agent based on their effect on gastrointestinal motility. AIM: This review aims to evaluate the current management strategies for high output stoma and explore the emerging evidence to support the use of GLP-1 analogues, with emphasis on mechanism, clinical efficacy, and adverse effects. METHODS: A comprehensive search of MEDLINE, Embase, Cochrane Library, and Scopus was performed to identify case studies, observational studies, and trials involving GLP-1 analogues in patients with enterostomy or enterocutaneous fistula. RESULTS: GLP-1 is an influential neurohormone in modulating gastrointestinal transit via its action on the ileal brake. We identified two case reports of GLP-1 analogue use in the management of high output stoma and three observational pilot studies. GLP-1 analogues demonstrated improvement in clinical parameters, including reduction in stoma output and parenteral support requirements. Nausea was the most reported adverse effect. Comparison across studies is limited by small sizes, variable dosing regimens, and differing primary endpoints. CONCLUSION: Preliminary evidence based on reports and small observational studies is low quality but suggests GLP-1 analogues may be an efficacious therapy for high output stoma with no major reported safety concerns. Further studies, including randomized control trials are required to determine their role in the future management of high output stoma.