Association between GLP-1-based therapy and small-bowel transit time during capsule endoscopy: a prospective, multicentre, observational study.
Level 3 - non-randomized controlled study
Prospective multicentre non-randomised observational cohort study with concurrent controls
PubMed 42457308 · doi:10.1136/bmjgast-2026-002360
What was done
A prospective, multicentre, observational cohort study evaluated consecutive adults undergoing small-bowel capsule endoscopy for standard clinical indications. Patients taking GLP-1-based therapies (GLP-1 receptor agonists or dual GIP/GLP-1 receptor agonists; n=34) were compared to non-exposed controls (n=95). The primary outcome was small-bowel transit time. Secondary outcomes included gastric transit time, capsule completion rate, bowel preparation quality, repeat-examination recommendation, and endoscopic findings. Multivariable linear regression adjusted for age, body mass index, diabetes mellitus, and procedural indication.
What was found
GLP-1-exposed patients had significantly longer unadjusted median small-bowel transit time than controls (311.0 min [IQR 252.8–433.0] vs 236.0 min [IQR 188.0–282.5]; p < 0.001). After multivariable adjustment, GLP-1 therapy remained independently associated with longer small-bowel transit time (adjusted β +83 min, 95% CI 3.1 to 162.8; p = 0.042). Gastric transit time did not differ significantly (median 33.5 vs 22.5 min; p = 0.263). Differences were not statistically significant for capsule completion (91.2% vs 98.9%; p = 0.056), repeat capsule recommendations (11.8% vs 3.2%; p = 0.078), or clinically significant endoscopic findings (23.5% vs 34.7%; p = 0.322).
Why it matters
This study demonstrates that GLP-1-based medications prolong small-bowel transit during capsule endoscopy. The findings indicate that while small-bowel transit is delayed, routine pre-procedural discontinuation is not currently justified, though individualised patient assessment is warranted.
Limits
The total sample size was modest (n=129, with only 34 exposed), leaving the study underpowered to confirm whether trending reductions in completion rates (p=0.056) or increases in repeat examinations (p=0.078) reach clinical significance. Observational allocation allows potential residual confounding, and the abstract does not report specific drug dosages, treatment durations, or numerical scores for bowel preparation quality.
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