Elsevier

Gastrointestinal Endoscopy

Volume 72, Issue 6, December 2010, Pages 1138-1145
Gastrointestinal Endoscopy

Original Article: Clinical Endoscopy
Prokinetics in acute upper GI bleeding: a meta-analysis

https://doi.org/10.1016/j.gie.2010.08.011Get rights and content

Background

Recent data suggest that administration of prokinetics before gastroscopy may be useful in patients with acute upper GI bleeding (UGIB). Published studies are limited in the number of subjects evaluated, and the conclusions are disparate.

Objective

To assess the evidence of administering prokinetic agents before EGD in acute UGIB.

Design and Setting

Comprehensive literature searches from 1990 to January 2010 were performed. We selected for meta-analysis randomized trials assessing prokinetic agents in acute UGIB. The primary outcome was the need for a repeat EGD. Secondary outcomes included endoscopic visualization, blood transfusions, duration of hospitalization, and surgery. Results were reported as odds ratios (ORs) or weighted mean differences (WMDs).

Results

From 487 citations identified, we selected 3 fully published articles and 2 abstracts assessing a total of 316 patients. Erythromycin (3 studies) and metoclopramide (2 studies) were compared with either placebo (2 studies) or no treatment (3 studies). A prokinetic agent significantly reduced the need for repeat EGD (OR 0.55; 95% CI, 0.32-0.94). The number of units of blood was not significantly altered (WMD, −0.40; 95% CI, −0.86 to 0.06) nor was hospital stay (WMD, −1.04; 95% CI, −2.83 to 0.76) or the need for surgery (OR 1.11; 95% CI, 0.27-4.67). Endoscopic visualization was not analyzed because the disparate definitions across studies did not allow for meaningful clinical inferences.

Limitations

The results are limited by the small number of subjects.

Conclusions

Intravenous erythromycin or metoclopramide immediately before EGD in acute UGIB patients decreases the need for a repeat EGD, but does not improve other clinically relevant measurable outcomes.

Section snippets

Search strategy

A computerized medical literature search was initiated from January 1990 to January 2010 using OVID MEDLINE (1990 to January 2010), EMBASE (1990 to the first week of 2010), CENTRAL (1st quarter of 2010), and ISI Web of Knowledge 4.0. Abstracts for the past 5 years from Digestive Disease Week and United European Gastroenterology Week (UEGW) were also hand searched as was a clinical trials database (www.clinicaltrials.gov). To select articles, a highly sensitive search strategy was used to

Included studies

From a total of 487 citations identified through the systematic review, 478 articles were excluded because they did not address the topic under study. One article had no randomization performed, 1 had different outcomes assessed, 1 presented insufficient information, and a last was excluded because its results were not available in either English or French. The corresponding Quorum diagram is shown in Figure 1.16 Three fully published articles and 2 clinical studies6, 7, 8 published only in

Discussion

Erythromycin exhibits motilin agonist properties and is used in gastroparesis.21 Its safety profile as an antibiotic is also quite favorable, with caution needed in patients with a prolonged QT interval.22 Its administration and that of metoclopramide before endoscopy have been recently studied in UGIB patients.

The administration of erythromycin or metoclopramide to patients with evidence of ongoing active bleeding and blood in the stomach (hematemesis or coffee ground vomiting and bloody

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  • Cited by (0)

    DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Dr. Barkun: speaker and consultant for and research support from Olympus; consultant for AstraZeneca. Dr. Bardou: financial support from AstraZeneca to attend DDW; consultant for Sanofi-Aventis and Ethypharm. All other authors disclosed no financial relationships relevant to this publication.

    See CME section; p. 1249

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