Association between GLP-1-based therapy and small-bowel transit time during capsule endoscopy: a prospective, multicentre, observational study.

OBJECTIVE

To evaluate the association between glucagon-like peptide-1 (GLP-1) based therapy and small-bowel transit time during capsule endoscopy.

METHODS

We conducted a prospective, multicentre, observational study of consecutive adults undergoing small-bowel capsule endoscopy for standard clinical indications. Patients receiving GLP-1-based therapy, defined as treatment with a GLP-1 receptor agonist or dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist, were compared with non-exposed controls. The primary outcome was small-bowel transit time. Secondary outcomes included gastric transit time, capsule completion, bowel preparation quality, repeat-examination recommendation and endoscopic findings.

RESULTS

Among 129 participants, 34 were receiving GLP-1-based therapy and 95 were non-exposed controls. Exposed patients had longer unadjusted small-bowel transit time than controls (median 311.0 (IQR 252.8-433.0) vs 236.0 (188.0-282.5) min; p<0.001). Gastric transit time was not significantly different between groups (33.5 (15.2-51.8) vs 22.5 (11.0-42.5) min; p=0.263). Capsule completion was numerically lower among exposed patients, but the difference was not statistically significant (91.2% vs 98.9%; p=0.056). Repeat capsule recommendation (11.8% vs 3.2%; p=0.078) and clinically significant endoscopic findings (23.5% vs 34.7%; p=0.322) were also not significantly different. In multivariable linear regression restricted to examinations with calculable small-bowel transit time and complete covariate data, GLP-1-based therapy was independently associated with longer small-bowel transit time after adjustment for age, body mass index, diabetes mellitus and indication for capsule endoscopy (adjusted β+83 min, 95% CI 3.1 to 162.8; p=0.042).

CONCLUSION

GLP-1-based therapy was associated with longer small-bowel transit time during capsule endoscopy. These findings do not support routine discontinuation of GLP-1-based therapy before capsule endoscopy, but they support individualised assessment and larger studies powered to evaluate capsule completion and repeat examination.