## EGD rows: 469 | Colonoscopy rows: 591

Project 1: EGD — Obesity & Aspiration Risk

Primary outcome: Evidence of retained gastric contents
Secondary outcomes: Aborted EGD; amount of retained gastric contents

Including Rybelsus & Liraglutide

Cohort N = 469

Table 1: Patient Characteristics

Table 1. Patient Characteristics — EGD (All GLP-1 Agents)
Characteristic Overall
N = 4691		 Non-Obese
N = 1571		 Obese
N = 3121		 p-value2
Age (years) 57.8 ± 13.9 65.3 ± 11.0 54.1 ± 13.6 <0.001
BMI (kg/m²) 34.7 ± 8.8 26.1 ± 2.9 39.0 ± 7.5 <0.001
Sex


<0.001
    Female 294 (62.7%) 80 (51.0%) 214 (68.6%)
    Male 175 (37.3%) 77 (49.0%) 98 (31.4%)
Race/Ethnicity



    White 161 (34.3%) 63 (40.1%) 98 (31.4%)
    Black 77 (16.4%) 17 (10.8%) 60 (19.2%)
    Hispanic 120 (25.6%) 46 (29.3%) 74 (23.7%)
    Asian 6 (1.3%) 4 (2.5%) 2 (0.6%)
    Other 39 (8.3%) 7 (4.5%) 32 (10.3%)
    Not Disclosed 66 (14.1%) 20 (12.7%) 46 (14.7%)
Insurance


0.195
    Non-Medicaid 366 (78.0%) 128 (81.5%) 238 (76.3%)
    Medicaid 103 (22.0%) 29 (18.5%) 74 (23.7%)
Parkinson's Disease 2 (0.4%) 1 (0.6%) 1 (0.3%) >0.999
Hypothyroidism 44 (9.4%) 15 (9.6%) 29 (9.3%) 0.928
Hyperthyroidism 0 (0.0%) 0 (0.0%) 0 (0.0%) >0.999
Scleroderma 0 (0.0%) 0 (0.0%) 0 (0.0%) >0.999
Gastroparesis 6 (1.3%) 0 (0.0%) 6 (1.9%) 0.185
Diabetes 356 (75.9%) 133 (84.7%) 223 (71.5%) 0.002
Opioid Use 7 (1.5%) 1 (0.6%) 6 (1.9%) 0.433
Secretagogue Use 7 (1.5%) 2 (1.3%) 5 (1.6%) >0.999
Prior Bariatric Surgery 69 (14.7%) 15 (9.6%) 54 (17.3%) 0.025
GLP-1 Agent


0.099
    dulaglutide 125 (26.7%) 50 (31.8%) 75 (24.0%)
    exenatide 6 (1.3%) 3 (1.9%) 3 (1.0%)
    liraglutide 45 (9.6%) 12 (7.6%) 33 (10.6%)
    rybelsus 43 (9.2%) 19 (12.1%) 24 (7.7%)
    semaglutide 245 (52.2%) 71 (45.2%) 174 (55.8%)
    tirzepatide 5 (1.1%) 2 (1.3%) 3 (1.0%)
1 Mean ± SD; n (%)
2 Wilcoxon rank sum test; Pearson’s Chi-squared test; NA; Fisher’s exact test

Primary Outcome: Retained Gastric Contents

Retained Gastric Contents by Obesity Status
Obesity Status N Retained Gastric Contents (n) Rate (%)
Non-Obese 157 20 12.7
Obese 312 34 10.9 
## Pearson Chi-Square Test : p = 0.555
##            
##              No Yes
##   Non-Obese 137  20
##   Obese     278  34

Amount of retained gastric contents

Amount of Retained Gastric Contents (among those with retention)
Obesity Status Amount n %
Non-Obese Small 7 35.0
Non-Obese Moderate 6 30.0
Non-Obese Large 7 35.0
Obese Small 7 20.6
Obese Moderate 17 50.0
Obese Large 10 29.4

Secondary Outcome: Aborted EGD

Aborted EGD by Obesity Status
Obesity Status N Aborted EGD (n) Rate (%)
Non-Obese 157 4 2.5
Obese 312 4 1.3 
## Fisher's Exact Test : p = 0.451
##            
##              No Yes
##   Non-Obese 153   4
##   Obese     308   4

Univariable Regression

Outcome: Retained Gastric Contents

Univariable Logistic Regression: Retained Gastric Contents — All GLP-1 Agents
Characteristic N OR 95% CI p-value
obese 469


    Non-Obese
— —
    Obese
0.84 0.47, 1.53 0.556
age 469 1.0 0.98, 1.02 0.622
sex_f 469


    Female
— —
    Male
1.66 0.93, 2.94 0.082
race_f 469


    White
— —
    Black
0.60 0.21, 1.47 0.288
    Hispanic
1.01 0.49, 2.05 0.984
    Asian
0.00
0.988
    Other
1.04 0.33, 2.78 0.946
    Not Disclosed
0.97 0.38, 2.26 0.950
insurance_f 469


    Non-Medicaid
— —
    Medicaid
1.14 0.57, 2.18 0.690
parkinsons 469


    No
— —
    Yes
7.81 0.31, 199 0.148
hypothyroid 469


    No
— —
    Yes
0.98 0.33, 2.41 0.974
gastroparesis 469


    No
— —
    Yes
1.55 0.08, 9.83 0.693
diabetes 469


    No
— —
    Yes
1.13 0.59, 2.31 0.733
opioid 469


    No
— —
    Yes
3.15 0.44, 15.0 0.176
secretagogue 469


    No
— —
    Yes
3.15 0.44, 15.0 0.176
bariatric_surg_yn 469


    No
— —
    Yes
0.70 0.26, 1.58 0.429
glp1_type 469


    dulaglutide
— —
    exenatide
0.00
0.988
    liraglutide
0.99 0.30, 2.78 0.987
    rybelsus
0.39 0.06, 1.46 0.222
    semaglutide
1.23 0.65, 2.47 0.536
    tirzepatide
0.00
0.989
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted EGD

Univariable Logistic Regression: Aborted EGD — All GLP-1 Agents
Characteristic N OR 95% CI p-value
obese 469


    Non-Obese
— —
    Obese
0.50 0.12, 2.13 0.327
age 469 0.95 0.90, 0.99 0.026
sex_f 469


    Female
— —
    Male
2.85 0.69, 14.0 0.155
race_f 469


    White
— —
    Black
0.00
0.994
    Hispanic
2.04 0.33, 15.7 0.439
    Asian
0.00
0.998
    Other
2.09 0.10, 22.4 0.551
    Not Disclosed
2.48 0.29, 21.1 0.368
insurance_f 469


    Non-Medicaid
— —
    Medicaid
2.17 0.44, 8.98 0.296
parkinsons 469


    No
— —
    Yes
0.00
0.994
hypothyroid 469


    No
— —
    Yes
0.00
0.992
gastroparesis 469


    No
— —
    Yes
0.00
0.993
diabetes 469


    No
— —
    Yes
0.95 0.22, 6.56 0.952
opioid 469


    No
— —
    Yes
0.00
0.993
secretagogue 469


    No
— —
    Yes
0.00
0.993
bariatric_surg_yn 469


    No
— —
    Yes
0.00
0.990
glp1_type 469


    dulaglutide
— —
    exenatide
0.00
0.997
    liraglutide
2.82 0.11, 72.3 0.467
    rybelsus
0.00
0.993
    semaglutide
3.11 0.52, 59.1 0.296
    tirzepatide
0.00
0.998
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Multivariable Regression

Covariates: obesity, age, sex, GLP-1 type, prior bariatric surgery, diabetes, opioids

Outcome: Retained Gastric Contents

Multivariable Logistic Regression: Retained Gastric Contents — All GLP-1 Agents
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 0.75 0.39, 1.46 0.4
age 0.99 0.97, 1.01 0.4
sex_f


    Female — —
    Male 1.65 0.90, 3.02 0.10
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    liraglutide 1.08 0.33, 3.07 0.9
    rybelsus 0.40 0.06, 1.53 0.2
    semaglutide 1.35 0.69, 2.77 0.4
    tirzepatide 0.00
>0.9
bariatric_surg_yn


    No — —
    Yes 0.72 0.25, 1.76 0.5
diabetes


    No — —
    Yes 1.07 0.53, 2.29 0.9
opioid


    No — —
    Yes 4.52 0.60, 23.6 0.089
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted EGD

Multivariable Logistic Regression: Aborted EGD — All GLP-1 Agents
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 0.13 0.02, 0.78 0.029
age 0.91 0.85, 0.97 0.004
sex_f


    Female — —
    Male 2.86 0.62, 16.3 0.2
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    liraglutide 4.66 0.17, 129 0.3
    rybelsus 0.00
>0.9
    semaglutide 3.81 0.57, 75.6 0.2
    tirzepatide 0.00
>0.9
bariatric_surg_yn


    No — —
    Yes 0.00
>0.9
diabetes


    No — —
    Yes 1.68 0.29, 14.9 0.6
opioid


    No — —
    Yes 0.00
>0.9
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Excluding Rybelsus & Liraglutide

Cohort N = 381 (rybelsus and liraglutide excluded)

Table 1: Patient Characteristics

Table 1. Patient Characteristics — EGD (Excluding Rybelsus & Liraglutide)
Characteristic Overall
N = 3811		 Non-Obese
N = 1261		 Obese
N = 2551		 p-value2
Age (years) 57.4 ± 13.8 64.1 ± 11.0 54.1 ± 13.8 <0.001
BMI (kg/m²) 34.8 ± 9.1 25.9 ± 3.0 39.2 ± 7.8 <0.001
Sex


0.008
    Female 238 (62.5%) 67 (53.2%) 171 (67.1%)
    Male 143 (37.5%) 59 (46.8%) 84 (32.9%)
Race/Ethnicity


0.149
    White 138 (36.2%) 51 (40.5%) 87 (34.1%)
    Black 61 (16.0%) 15 (11.9%) 46 (18.0%)
    Hispanic 101 (26.5%) 36 (28.6%) 65 (25.5%)
    Asian 6 (1.6%) 4 (3.2%) 2 (0.8%)
    Other 32 (8.4%) 7 (5.6%) 25 (9.8%)
    Not Disclosed 43 (11.3%) 13 (10.3%) 30 (11.8%)
Insurance


0.282
    Non-Medicaid 296 (77.7%) 102 (81.0%) 194 (76.1%)
    Medicaid 85 (22.3%) 24 (19.0%) 61 (23.9%)
Parkinson's Disease 2 (0.5%) 1 (0.8%) 1 (0.4%) 0.553
Hypothyroidism 39 (10.2%) 14 (11.1%) 25 (9.8%) 0.692
Hyperthyroidism 0 (0.0%) 0 (0.0%) 0 (0.0%) >0.999
Scleroderma 0 (0.0%) 0 (0.0%) 0 (0.0%) >0.999
Gastroparesis 6 (1.6%) 0 (0.0%) 6 (2.4%) 0.184
Diabetes 288 (75.6%) 104 (82.5%) 184 (72.2%) 0.026
Opioid Use 5 (1.3%) 0 (0.0%) 5 (2.0%) 0.175
Secretagogue Use 6 (1.6%) 1 (0.8%) 5 (2.0%) 0.668
Prior Bariatric Surgery 54 (14.2%) 13 (10.3%) 41 (16.1%) 0.129
GLP-1 Agent


0.098
    dulaglutide 125 (32.8%) 50 (39.7%) 75 (29.4%)
    exenatide 6 (1.6%) 3 (2.4%) 3 (1.2%)
    liraglutide 0 (0.0%) 0 (0.0%) 0 (0.0%)
    rybelsus 0 (0.0%) 0 (0.0%) 0 (0.0%)
    semaglutide 245 (64.3%) 71 (56.3%) 174 (68.2%)
    tirzepatide 5 (1.3%) 2 (1.6%) 3 (1.2%)
1 Mean ± SD; n (%)
2 Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test

Primary Outcome: Retained Gastric Contents

Retained Gastric Contents by Obesity Status
Obesity Status N Retained Gastric Contents (n) Rate (%)
Non-Obese 126 18 14.3
Obese 255 29 11.4 
## Pearson Chi-Square Test : p = 0.416
##            
##              No Yes
##   Non-Obese 108  18
##   Obese     226  29

Amount of retained gastric contents

Amount of Retained Gastric Contents (among those with retention)
Obesity Status Amount n %
Non-Obese Small 6 33.3
Non-Obese Moderate 6 33.3
Non-Obese Large 6 33.3
Obese Small 6 20.7
Obese Moderate 15 51.7
Obese Large 8 27.6

Secondary Outcome: Aborted EGD

Aborted EGD by Obesity Status
Obesity Status N Aborted EGD (n) Rate (%)
Non-Obese 126 3 2.4
Obese 255 4 1.6 
## Fisher's Exact Test : p = 0.689
##            
##              No Yes
##   Non-Obese 123   3
##   Obese     251   4

Univariable Regression

Outcome: Retained Gastric Contents

Univariable Logistic Regression: Retained Gastric Contents — Excluding Daily GLP-1s
Characteristic N OR 95% CI p-value
obese 381


    Non-Obese
— —
    Obese
0.77 0.41, 1.47 0.417
age 381 1.00 0.97, 1.02 0.720
sex_f 381


    Female
— —
    Male
1.89 1.02, 3.50 0.043
race_f 381


    White
— —
    Black
0.60 0.19, 1.58 0.328
    Hispanic
1.16 0.55, 2.43 0.689
    Asian
0.00
0.988
    Other
1.23 0.38, 3.42 0.701
    Not Disclosed
0.68 0.19, 1.97 0.514
insurance_f 381


    Non-Medicaid
— —
    Medicaid
1.23 0.58, 2.42 0.571
parkinsons 381


    No
— —
    Yes
7.24 0.28, 185 0.164
hypothyroid 381


    No
— —
    Yes
0.56 0.13, 1.65 0.358
gastroparesis 381


    No
— —
    Yes
1.43 0.07, 9.13 0.746
diabetes 381


    No
— —
    Yes
1.22 0.60, 2.70 0.594
opioid 381


    No
— —
    Yes
1.79 0.09, 12.5 0.605
secretagogue 381


    No
— —
    Yes
3.67 0.50, 19.3 0.140
bariatric_surg_yn 381


    No
— —
    Yes
0.38 0.09, 1.09 0.114
glp1_type 381


    dulaglutide
— —
    exenatide
0.00
0.988
    semaglutide
1.23 0.65, 2.47 0.536
    tirzepatide
0.00
0.989
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted EGD

Univariable Logistic Regression: Aborted EGD — Excluding Daily GLP-1s
Characteristic N OR 95% CI p-value
obese 381


    Non-Obese
— —
    Obese
0.65 0.14, 3.36 0.581
age 381 0.93 0.88, 0.98 0.014
sex_f 381


    Female
— —
    Male
4.28 0.91, 30.1 0.085
race_f 381


    White
— —
    Black
0.00
0.994
    Hispanic
2.08 0.34, 16.0 0.427
    Asian
0.00
0.998
    Other
2.19 0.10, 23.6 0.527
    Not Disclosed
1.62 0.07, 17.3 0.697
insurance_f 381


    Non-Medicaid
— —
    Medicaid
2.67 0.52, 12.3 0.204
parkinsons 381


    No
— —
    Yes
0.00
0.994
hypothyroid 381


    No
— —
    Yes
0.00
0.993
gastroparesis 381


    No
— —
    Yes
0.00
0.993
diabetes 381


    No
— —
    Yes
0.80 0.17, 5.68 0.796
opioid 381


    No
— —
    Yes
0.00
0.994
secretagogue 381


    No
— —
    Yes
0.00
0.993
bariatric_surg_yn 381


    No
— —
    Yes
0.00
0.991
glp1_type 381


    dulaglutide
— —
    exenatide
0.00
0.996
    semaglutide
3.11 0.52, 59.1 0.296
    tirzepatide
0.00
0.996
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Multivariable Regression

Covariates: obesity, age, sex, GLP-1 type, prior bariatric surgery, diabetes, opioids

Outcome: Retained Gastric Contents

Multivariable Logistic Regression: Retained Gastric Contents — Excluding Daily GLP-1s
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 0.71 0.35, 1.45 0.3
age 0.99 0.97, 1.01 0.4
sex_f


    Female — —
    Male 1.72 0.91, 3.27 0.10
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    semaglutide 1.42 0.72, 2.93 0.3
    tirzepatide 0.00
>0.9
bariatric_surg_yn


    No — —
    Yes 0.41 0.09, 1.25 0.2
diabetes


    No — —
    Yes 1.17 0.55, 2.68 0.7
opioid


    No — —
    Yes 2.80 0.14, 21.9 0.4
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted EGD

Multivariable Logistic Regression: Aborted EGD — Excluding Daily GLP-1s
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 0.14 0.01, 1.06 0.062
age 0.90 0.83, 0.96 0.005
sex_f


    Female — —
    Male 5.59 1.02, 48.6 0.068
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    semaglutide 3.72 0.54, 75.0 0.2
    tirzepatide 0.00
>0.9
bariatric_surg_yn


    No — —
    Yes 0.00
>0.9
diabetes


    No — —
    Yes 1.38 0.22, 13.0 0.7
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Project 2: Colonoscopy — Obesity & Bowel Prep Adequacy

Primary outcome: Inadequate bowel prep (unsatisfactory, poor, or inadequate)
Secondary outcomes: BBPS score; aborted colonoscopy

Including Rybelsus & Liraglutide

Cohort N = 591

Table 1: Patient Characteristics

Table 1. Patient Characteristics — Colonoscopy (All GLP-1 Agents)
Characteristic Overall
N = 5911		 Non-Obese
N = 2491		 Obese
N = 3421		 p-value2
Age (years) 61.8 ± 10.3 64.5 ± 9.6 59.7 ± 10.2 <0.001
BMI (kg/m²) 31.9 ± 6.7 26.0 ± 2.8 36.3 ± 5.2 <0.001
Sex


<0.001
    Female 341 (57.7%) 114 (45.8%) 227 (66.4%)
    Male 250 (42.3%) 135 (54.2%) 115 (33.6%)
Race/Ethnicity



    White 177 (29.9%) 80 (32.1%) 97 (28.4%)
    Black 108 (18.3%) 28 (11.2%) 80 (23.4%)
    Hispanic 51 (8.6%) 24 (9.6%) 27 (7.9%)
    Asian 6 (1.0%) 3 (1.2%) 3 (0.9%)
    Other 236 (39.9%) 110 (44.2%) 126 (36.8%)
    Not Disclosed 13 (2.2%) 4 (1.6%) 9 (2.6%)
Insurance


0.694
    Non-Medicaid 475 (80.4%) 202 (81.1%) 273 (79.8%)
    Medicaid 116 (19.6%) 47 (18.9%) 69 (20.2%)
Parkinson's Disease 4 (0.7%) 3 (1.2%) 1 (0.3%) 0.315
Hypothyroidism 59 (10.0%) 28 (11.2%) 31 (9.1%) 0.383
Hyperthyroidism 4 (0.7%) 2 (0.8%) 2 (0.6%) >0.999
Scleroderma 0 (0.0%) 0 (0.0%) 0 (0.0%) >0.999
Gastroparesis 4 (0.7%) 1 (0.4%) 3 (0.9%) 0.642
Diabetes 495 (83.8%) 227 (91.2%) 268 (78.4%) <0.001
Opioid Use 9 (1.5%) 5 (2.0%) 4 (1.2%) 0.503
Secretagogue Use 7 (1.2%) 4 (1.6%) 3 (0.9%) 0.462
GLP-1 Agent



    dulaglutide 182 (30.8%) 95 (38.3%) 87 (25.4%)
    exenatide 4 (0.7%) 1 (0.4%) 3 (0.9%)
    liraglutide 53 (9.0%) 15 (6.0%) 38 (11.1%)
    rybelsus 43 (7.3%) 24 (9.7%) 19 (5.6%)
    semaglutide 292 (49.5%) 104 (41.9%) 188 (55.0%)
    tirzepatide 16 (2.7%) 9 (3.6%) 7 (2.0%)
Indication


0.114
    Screening 366 (61.9%) 145 (58.2%) 221 (64.6%)
    Not Screening 225 (38.1%) 104 (41.8%) 121 (35.4%)
1 Mean ± SD; n (%)
2 Wilcoxon rank sum test; Pearson’s Chi-squared test; NA; Fisher’s exact test

Primary Outcome: Inadequate Bowel Prep

Inadequate Bowel Prep by Obesity Status
Obesity Status N Inadequate Prep (n) Rate (%)
Non-Obese 249 31 12.4
Obese 342 42 12.3 
## Pearson Chi-Square Test : p = 0.951
##            
##              No Yes
##   Non-Obese 218  31
##   Obese     300  42

Full bowel prep rating distribution

Bowel Prep Rating Distribution by Obesity Status
Obesity Status Prep Rating n %
Non-Obese Adequate 52 20.9
Non-Obese Excellent 36 14.5
Non-Obese Fair 16 6.4
Non-Obese Good 105 42.2
Non-Obese Other 15 6.0
Non-Obese Poor 25 10.0
Obese Adequate 55 16.1
Obese Excellent 41 12.0
Obese Fair 27 7.9
Obese Good 167 48.8
Obese Inadequate/Unsatisfactory 5 1.5
Obese Other 18 5.3
Obese Poor 29 8.5

Secondary Outcome: BBPS Score

Boston Bowel Prep Score (BBPS) by Obesity Status
Obesity Status N Mean SD Median IQR
Non-Obese 30 7.00 2.33 8 3
Obese 22 7.23 2.54 9 3 
## Independent samples t-test: t = -0.330, df = 43.1, p = 0.743

Secondary Outcome: Aborted Colonoscopy

Aborted Colonoscopy by Obesity Status
Obesity Status N Aborted (n) Rate (%)
Non-Obese 249 19 7.6
Obese 341 18 5.3 
## Pearson Chi-Square Test : p = 0.245
##            
##              No Yes
##   Non-Obese 230  19
##   Obese     323  18

Univariable Regression

Outcome: Inadequate Bowel Prep

Univariable Logistic Regression: Inadequate Bowel Prep — All GLP-1 Agents
Characteristic N OR 95% CI p-value
obese 591


    Non-Obese
— —
    Obese
0.98 0.60, 1.63 0.951
age 591 0.99 0.97, 1.02 0.485
sex_f 591


    Female
— —
    Male
1.38 0.84, 2.26 0.196
race_f 591


    White
— —
    Black
1.68 0.84, 3.32 0.136
    Hispanic
0.85 0.27, 2.24 0.763
    Asian
0.00
0.982
    Other
1.06 0.58, 1.97 0.859
    Not Disclosed
0.65 0.03, 3.60 0.691
insurance_f 591


    Non-Medicaid
— —
    Medicaid
0.87 0.44, 1.60 0.676
parkinsons 591


    No
— —
    Yes
2.38 0.12, 18.9 0.454
hypothyroid 591


    No
— —
    Yes
0.49 0.14, 1.24 0.179
gastroparesis 591


    No
— —
    Yes
2.38 0.12, 18.9 0.454
diabetes 591


    No
— —
    Yes
0.88 0.48, 1.74 0.699
opioid 591


    No
— —
    Yes
5.95 1.44, 23.0 0.009
secretagogue 591


    No
— —
    Yes
1.19 0.06, 7.07 0.876
glp1_type 590


    dulaglutide
— —
    exenatide
0.00
0.985
    liraglutide
0.40 0.11, 1.07 0.097
    rybelsus
0.79 0.28, 1.92 0.625
    semaglutide
0.56 0.32, 0.96 0.034
    tirzepatide
0.70 0.11, 2.66 0.643
indication 591


    Screening
— —
    Not Screening
1.69 1.03, 2.78 0.036
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted Colonoscopy

Univariable Logistic Regression: Aborted Colonoscopy — All GLP-1 Agents
Characteristic N OR 95% CI p-value
obese 590


    Non-Obese
— —
    Obese
0.67 0.34, 1.32 0.247
age 590 1.02 0.98, 1.05 0.358
sex_f 590


    Female
— —
    Male
1.65 0.85, 3.26 0.141
race_f 590


    White
— —
    Black
1.69 0.60, 4.73 0.309
    Hispanic
0.86 0.13, 3.58 0.854
    Asian
4.23 0.21, 30.7 0.212
    Other
1.75 0.77, 4.36 0.199
    Not Disclosed
0.00 0.00, 34,546,481,923,038,820 0.989
insurance_f 590


    Non-Medicaid
— —
    Medicaid
0.34 0.08, 0.98 0.081
parkinsons 590


    No
— —
    Yes
5.09 0.25, 40.9 0.163
hypothyroid 590


    No
— —
    Yes
0.78 0.18, 2.27 0.693
gastroparesis 590


    No
— —
    Yes
5.09 0.25, 40.9 0.163
diabetes 590


    No
— —
    Yes
1.65 0.64, 5.62 0.357
opioid 590


    No
— —
    Yes
4.46 0.65, 19.3 0.069
secretagogue 590


    No
— —
    Yes
2.53 0.13, 15.4 0.396
glp1_type 589


    dulaglutide
— —
    exenatide
0.00
0.994
    liraglutide
0.18 0.01, 0.90 0.098
    rybelsus
0.22 0.01, 1.10 0.142
    semaglutide
0.53 0.26, 1.07 0.074
    tirzepatide
0.00
0.988
indication 590


    Screening
— —
    Not Screening
0.99 0.49, 1.94 0.969
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Multivariable Regression

Covariates: obesity, age, sex, GLP-1 type, diabetes
(Prior bariatric surgery not collected in colonoscopy dataset)

Outcome: Inadequate Bowel Prep

Multivariable Logistic Regression: Inadequate Bowel Prep — All GLP-1 Agents
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 1.20 0.70, 2.09 0.5
age 0.99 0.96, 1.01 0.3
sex_f


    Female — —
    Male 1.50 0.89, 2.53 0.13
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    liraglutide 0.39 0.11, 1.07 0.10
    rybelsus 0.87 0.30, 2.14 0.8
    semaglutide 0.54 0.30, 0.95 0.034
    tirzepatide 0.76 0.11, 3.05 0.7
diabetes


    No — —
    Yes 0.88 0.45, 1.83 0.7
indication


    Screening — —
    Not Screening 1.78 1.07, 2.98 0.027
opioid


    No — —
    Yes 6.54 1.53, 26.5 0.008
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted Colonoscopy

Multivariable Logistic Regression: Aborted Colonoscopy — All GLP-1 Agents
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 0.93 0.44, 1.96 0.8
age 1.01 0.98, 1.05 0.5
sex_f


    Female — —
    Male 1.44 0.71, 2.95 0.3
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    liraglutide 0.19 0.01, 0.98 0.11
    rybelsus 0.21 0.01, 1.10 0.14
    semaglutide 0.55 0.26, 1.15 0.11
    tirzepatide 0.00 0.00, 5,881,975,786,396 >0.9
diabetes


    No — —
    Yes 1.18 0.42, 4.19 0.8
indication


    Screening — —
    Not Screening 0.83 0.39, 1.69 0.6
opioid


    No — —
    Yes 4.74 0.65, 22.5 0.070
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Excluding Rybelsus & Liraglutide

Cohort N = 495 (rybelsus and liraglutide excluded)

Table 1: Patient Characteristics

Table 1. Patient Characteristics — Colonoscopy (Excluding Rybelsus & Liraglutide)
Characteristic Overall
N = 4951		 Non-Obese
N = 2101		 Obese
N = 2851		 p-value2
Age (years) 61.6 ± 10.3 64.3 ± 9.5 59.6 ± 10.4 <0.001
BMI (kg/m²) 31.8 ± 6.8 25.9 ± 2.8 36.2 ± 5.3 <0.001
Sex


<0.001
    Female 290 (58.6%) 101 (48.1%) 189 (66.3%)
    Male 205 (41.4%) 109 (51.9%) 96 (33.7%)
Race/Ethnicity


0.018
    White 153 (30.9%) 70 (33.3%) 83 (29.1%)
    Black 91 (18.4%) 24 (11.4%) 67 (23.5%)
    Hispanic 39 (7.9%) 16 (7.6%) 23 (8.1%)
    Asian 6 (1.2%) 3 (1.4%) 3 (1.1%)
    Other 195 (39.4%) 93 (44.3%) 102 (35.8%)
    Not Disclosed 11 (2.2%) 4 (1.9%) 7 (2.5%)
Insurance


0.391
    Non-Medicaid 399 (80.6%) 173 (82.4%) 226 (79.3%)
    Medicaid 96 (19.4%) 37 (17.6%) 59 (20.7%)
Parkinson's Disease 4 (0.8%) 3 (1.4%) 1 (0.4%) 0.316
Hypothyroidism 53 (10.7%) 24 (11.4%) 29 (10.2%) 0.656
Hyperthyroidism 3 (0.6%) 1 (0.5%) 2 (0.7%) >0.999
Scleroderma 0 (0.0%) 0 (0.0%) 0 (0.0%) >0.999
Gastroparesis 4 (0.8%) 1 (0.5%) 3 (1.1%) 0.641
Diabetes 410 (82.8%) 189 (90.0%) 221 (77.5%) <0.001
Opioid Use 9 (1.8%) 5 (2.4%) 4 (1.4%) 0.504
Secretagogue Use 6 (1.2%) 3 (1.4%) 3 (1.1%) 0.702
GLP-1 Agent


0.001
    dulaglutide 182 (36.8%) 95 (45.5%) 87 (30.5%)
    exenatide 4 (0.8%) 1 (0.5%) 3 (1.1%)
    liraglutide 0 (0.0%) 0 (0.0%) 0 (0.0%)
    rybelsus 0 (0.0%) 0 (0.0%) 0 (0.0%)
    semaglutide 292 (59.1%) 104 (49.8%) 188 (66.0%)
    tirzepatide 16 (3.2%) 9 (4.3%) 7 (2.5%)
Indication


0.035
    Screening 307 (62.0%) 119 (56.7%) 188 (66.0%)
    Not Screening 188 (38.0%) 91 (43.3%) 97 (34.0%)
1 Mean ± SD; n (%)
2 Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test

Primary Outcome: Inadequate Bowel Prep

Inadequate Bowel Prep by Obesity Status
Obesity Status N Inadequate Prep (n) Rate (%)
Non-Obese 210 26 12.4
Obese 285 37 13.0 
## Pearson Chi-Square Test : p = 0.843
##            
##              No Yes
##   Non-Obese 184  26
##   Obese     248  37

Full bowel prep rating distribution

Bowel Prep Rating Distribution by Obesity Status
Obesity Status Prep Rating n %
Non-Obese Adequate 47 22.4
Non-Obese Excellent 30 14.3
Non-Obese Fair 14 6.7
Non-Obese Good 89 42.4
Non-Obese Other 10 4.8
Non-Obese Poor 20 9.5
Obese Adequate 44 15.4
Obese Excellent 33 11.6
Obese Fair 23 8.1
Obese Good 143 50.2
Obese Inadequate/Unsatisfactory 3 1.1
Obese Other 12 4.2
Obese Poor 27 9.5

Secondary Outcome: BBPS Score

Boston Bowel Prep Score (BBPS) by Obesity Status
Obesity Status N Mean SD Median IQR
Non-Obese 23 6.96 2.50 8 3
Obese 13 7.38 2.29 9 3 
## Independent samples t-test: t = -0.521, df = 26.9, p = 0.607

Secondary Outcome: Aborted Colonoscopy

Aborted Colonoscopy by Obesity Status
Obesity Status N Aborted (n) Rate (%)
Non-Obese 210 18 8.6
Obese 285 17 6.0 
## Pearson Chi-Square Test : p = 0.264
##            
##              No Yes
##   Non-Obese 192  18
##   Obese     268  17

Univariable Regression

Outcome: Inadequate Bowel Prep

Univariable Logistic Regression: Inadequate Bowel Prep — Excluding Daily GLP-1s
Characteristic N OR 95% CI p-value
obese 495


    Non-Obese
— —
    Obese
1.06 0.62, 1.82 0.843
age 495 0.99 0.97, 1.02 0.509
sex_f 495


    Female
— —
    Male
1.66 0.98, 2.84 0.060
race_f 495


    White
— —
    Black
1.39 0.66, 2.89 0.377
    Hispanic
0.38 0.06, 1.40 0.208
    Asian
0.00
0.982
    Other
1.09 0.58, 2.07 0.801
    Not Disclosed
0.71 0.04, 4.00 0.746
insurance_f 495


    Non-Medicaid
— —
    Medicaid
0.66 0.30, 1.33 0.275
parkinsons 495


    No
— —
    Yes
2.31 0.11, 18.3 0.472
hypothyroid 495


    No
— —
    Yes
0.53 0.16, 1.36 0.238
gastroparesis 495


    No
— —
    Yes
2.31 0.11, 18.3 0.472
diabetes 495


    No
— —
    Yes
0.86 0.45, 1.77 0.673
opioid 495


    No
— —
    Yes
5.79 1.40, 22.5 0.010
secretagogue 495


    No
— —
    Yes
1.38 0.07, 8.73 0.772
glp1_type 494


    dulaglutide
— —
    exenatide
0.00
0.985
    semaglutide
0.56 0.32, 0.96 0.034
    tirzepatide
0.70 0.11, 2.66 0.643
indication 495


    Screening
— —
    Not Screening
1.58 0.92, 2.68 0.093
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted Colonoscopy

Univariable Logistic Regression: Aborted Colonoscopy — Excluding Daily GLP-1s
Characteristic N OR 95% CI p-value
obese 495


    Non-Obese
— —
    Obese
0.68 0.34, 1.35 0.266
age 495 1.02 0.98, 1.05 0.322
sex_f 495


    Female
— —
    Male
1.75 0.88, 3.53 0.112
race_f 495


    White
— —
    Black
1.28 0.41, 3.80 0.658
    Hispanic
0.98 0.14, 4.11 0.980
    Asian
3.63 0.18, 26.4 0.264
    Other
1.84 0.80, 4.60 0.164
    Not Disclosed
0.00 0.00, 34,093,868,763 0.985
insurance_f 495


    Non-Medicaid
— —
    Medicaid
0.37 0.09, 1.06 0.106
parkinsons 495


    No
— —
    Yes
4.48 0.22, 36.1 0.199
hypothyroid 495


    No
— —
    Yes
0.77 0.18, 2.25 0.672
gastroparesis 495


    No
— —
    Yes
4.48 0.22, 36.1 0.199
diabetes 495


    No
— —
    Yes
1.66 0.63, 5.68 0.355
opioid 495


    No
— —
    Yes
3.92 0.57, 17.0 0.096
secretagogue 495


    No
— —
    Yes
2.68 0.14, 17.2 0.375
glp1_type 494


    dulaglutide
— —
    exenatide
0.00
0.994
    semaglutide
0.53 0.26, 1.07 0.074
    tirzepatide
0.00
0.988
indication 495


    Screening
— —
    Not Screening
0.96 0.46, 1.93 0.916
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Multivariable Regression

Covariates: obesity, age, sex, GLP-1 type, diabetes, indication, opioids
(Prior bariatric surgery not collected in colonoscopy dataset)

Outcome: Inadequate Bowel Prep

Multivariable Logistic Regression: Inadequate Bowel Prep — Excluding Daily GLP-1s
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 1.31 0.73, 2.38 0.4
age 0.99 0.96, 1.02 0.4
sex_f


    Female — —
    Male 1.84 1.05, 3.26 0.034
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    semaglutide 0.53 0.30, 0.95 0.033
    tirzepatide 0.74 0.11, 3.02 0.7
diabetes


    No — —
    Yes 0.82 0.40, 1.78 0.6
indication


    Screening — —
    Not Screening 1.64 0.94, 2.86 0.082
opioid


    No — —
    Yes 6.81 1.58, 27.9 0.007
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Outcome: Aborted Colonoscopy

Multivariable Logistic Regression: Aborted Colonoscopy — Excluding Daily GLP-1s
Characteristic OR 95% CI p-value
obese


    Non-Obese — —
    Obese 0.93 0.43, 2.00 0.8
age 1.01 0.98, 1.05 0.5
sex_f


    Female — —
    Male 1.47 0.71, 3.08 0.3
glp1_type


    dulaglutide — —
    exenatide 0.00
>0.9
    semaglutide 0.55 0.26, 1.14 0.11
    tirzepatide 0.00 0.00, 143,567,391,971,239 >0.9
diabetes


    No — —
    Yes 1.09 0.39, 3.92 0.9
indication


    Screening — —
    Not Screening 0.78 0.36, 1.65 0.5
opioid


    No — —
    Yes 4.75 0.65, 22.7 0.070
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Additional Analyses

EGD: Amount of Retained Contents by Obesity Status

All GLP-1 Agents

Amount of Retained Gastric Contents by Obesity Status — All GLP-1 Agents
Characteristic Overall
N = 541		 Non-Obese
N = 201		 Obese
N = 341		 p-value2
Amount of Retained Contents


0.3
    Small 14 (25.9%) 7 (35.0%) 7 (20.6%)
    Moderate 23 (42.6%) 6 (30.0%) 17 (50.0%)
    Large 17 (31.5%) 7 (35.0%) 10 (29.4%)
1 n (%)
2 Fisher’s exact test

Interpretation: This table shows the distribution of small, moderate, and large amounts of retained contents among patients who had any retention, stratified by obesity status.

Excluding Rybelsus & Liraglutide

Amount of Retained Gastric Contents by Obesity Status — Excluding Rybelsus & Liraglutide
Characteristic Overall
N = 471		 Non-Obese
N = 181		 Obese
N = 291		 p-value2
Amount of Retained Contents


0.4
    Small 12 (25.5%) 6 (33.3%) 6 (20.7%)
    Moderate 21 (44.7%) 6 (33.3%) 15 (51.7%)
    Large 14 (29.8%) 6 (33.3%) 8 (27.6%)
1 n (%)
2 Fisher’s exact test