Erythromycin is preferable to metoclopramide as a prokinetic in acute upper GI bleeding

Daram, Sumanth; Garretson, Roland

doi:10.1016/j.gie.2011.01.059

Cited by 12 publications

(9 citation statements)

References 6 publications

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“…In 2010, the international consensus recommendations by Barkun et al [ 1 ] were published and despite the five published RCTs [ 11 - 13 , 16 , 17 ] and one meta-analysis [ 6 ] on the subject of erythromycin at time, the group recommended that promotility agents should not be routinely used prior to endoscopy in UGIB patients [ 1 ]. However, this recommendation included trials using erythromycin and metoclopramide which likely influenced the outcome consensus as metoclopramide seems to be less effective [ 19 ]. In 2011, two meta-analyses [ 7 , 8 ] were published including only studies using erythromycin and discovered that the use of erythromycin prior to endoscopy increased the odds of adequate gastric visualization while decreasing the odds of a second-look endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review

Rahman

Nguyen

Sohail

et al. 2016

aog

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BackgroundIn patients suffering from upper gastrointestinal bleeding (UGIB), adequate visualization is essential during endoscopy. Prior to endoscopy, erythromycin administration has been shown to enhance visualization in these patients; however, guidelines have not fully adopted this practice. Thus, we performed a comprehensive, up-to-date meta-analysis on the issue of erythromycin administration in this patient population.MethodsAfter searching multiple databases (November 2015), randomized controlled trials on adult subjects comparing administration of erythromycin before endoscopy in UGIB patients to no erythromycin or placebo were included. Pooled estimates of adequacy of gastric mucosa visualized, need for second endoscopy, duration of procedure, length of hospital stay, units of blood transfused, and need for emergent surgery using odds ratio (OR) or mean difference (MD) were calculated. Heterogeneity and publication bias were assessed.ResultsEight studies (n=598) were found to meet the inclusion criteria. Erythromycin administration showed statistically significant improvement in adequate gastric mucosa visualization (OR 4.14; 95% CI: 2.01-8.53, P<0.01) while reduced the need for a second-look endoscopy (OR 0.51; 95% CI: 0.34-0.77, P<0.01) and length of hospital stay (MD -1.75; 95% CI: -2.43 to -1.06, P<0.01). Duration of procedure (P=0.2), units of blood transfused (P=0.08), and need for emergent surgery (P=0.88) showed no significant differences.ConclusionPre-endoscopic erythromycin administration in UGIB patients significantly improves gastric mucosa visualization while reducing length of hospital stay and the need for second-look endoscopy.

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Section: Discussionmentioning

confidence: 99%

Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review

Rahman

Nguyen

Sohail

et al. 2016

aog

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“…Furthermore, Daram et al ., also demonstrated that metoclopramide is inferior to erythromycin infusion before endoscopy for patients with UGIB. [21]…”

Section: Discussionmentioning

confidence: 99%

“…Finally, this meta-analysis evaluated only erythromycin based on the possibility that metoclopramide may not be as effective, which has been our experience and experience of others. [621]…”

Section: Discussionmentioning

confidence: 99%

Administration of erythromycin before endoscopy in upper gastrointestinal bleeding: A meta-analysis of randomized controlled trials

Theivanayagam

Lim

Cobell

et al. 2013

Saudi J Gastroenterol

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Background/Aim:Erythromycin infusion before endoscopy in upper gastrointestinal bleeding (UGIB) has been hypothesized to aid in visualization and reduce the need for second-look endoscopy; however, the results have been controversial. To evaluate further, we performed a meta-analysis comparing the efficacy of erythromycin infusion before endoscopy in acute UGIB.Methods:Multiple databases were searched (March 2013). Only randomized controlled trials were included in the analysis. A meta-analysis for the effect of erythromycin or no erythromycin before endoscopy in UGIB were analyzed by calculating pooled estimates of primary (visualization of gastric mucosa and need for second endoscopy) and secondary (units of blood transfused, length of hospital stay, duration of the procedure) outcomes. Statistical analysis was performed using RevMan 5.1 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration).Results:Six studies (N = 558) met the inclusion criteria. Erythromycin infusion before endoscopy in UGIB demonstrated a statistically significant improvement in visualization of the gastric mucosa [odds ratio (OR) 3.43; 95% confidence interval (CI): 1.81 to 6.50, P < 0.01] compared with no erythromycin. In addition, erythromycin infusion before endoscopy resulted in a statistically significant decrease in the need for a second endoscopy (OR 0.47; 95% CI: 0.26 to 0.83, P = 0.01), units of blood transfused (WMD − 0.41; 95% CI: −0.82 to −0.01, P = 0.04), and the duration of hospital stay (WMD − 1.51; 95% CI: −2.45 to −0.56, P < 0.01).Conclusions:Erythromycin infusion before endoscopy in patients with UGIB significantly improves visualization of gastric mucosa while decreasing the need for a second endoscopy, units of blood transfused, and duration of hospital stay.

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“…There is a sound rationale for using prokinetics before endoscopy in upper GI bleeding to clear the stomach and improve both the endoscopic views and probably safety. Individual trials have shown inconsistent results, but recent meta-analyses showed that intravenous erythromycin before endoscopy was associated with meaningful clinical benefit in terms of improved mucosal visualisation, reduction in repeat endoscopy, and blood transfused as well as length of stay but that metoclopramide was less effective 34 – 36 . Erythromycin is probably underused and seems to be a simple intervention that would improve outcomes.…”

Section: Drug Therapymentioning

confidence: 99%

Recent advances in the management of peptic ulcer bleeding

Beales

2017

F1000Res

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Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70–90 g/l. Comparative studies have confirmed that the Glasgow–Blatchford score remains the most useful score for predicting the need for intervention as well as for identifying the lowest-risk patients suitable for outpatient management. New scores, including the AIMS65 and Progetto Nazionale Emorragia Digestiva score, may be more accurate in predicting mortality. Pre-endoscopy erythromycin appears to improve outcomes and is probably underused. High-dose oral proton pump inhibition (PPI) for 11 days after PPI infusion is advantageous in those with a Rockall score of 6 or more. Oral is as effective as parenteral iron at restoring haemoglobin levels after a peptic ulcer bleed and both are superior to placebo in this respect. Within endoscopic techniques, haemostatic powders and over-the-scope clips can be used when other methods have failed. A disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Non- Helicobacter pylori, non-aspirin/non-steroidal anti-inflammatory drug ulcers contribute an increasing percentage of bleeding peptic ulcers and are associated with a poor prognosis and high rebleeding rate. The optimal management of these ulcers remains to be determined.

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Erythromycin is preferable to metoclopramide as a prokinetic in acute upper GI bleeding

Cited by 12 publications

References 6 publications

Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review

Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review

Administration of erythromycin before endoscopy in upper gastrointestinal bleeding: A meta-analysis of randomized controlled trials

Recent advances in the management of peptic ulcer bleeding

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