Pre Endoscopy Use of Prokinetic Agent, Metoclopramide, to Influence Outcome in Upper GI Bleeding. Is There Evidence to Support Its Use?

Mujtaba, Ghulam; Arya, Vijay; Mathur, Siddharth; Gupta, Ajay; Krishnaiah, Mahesh; Momeni, Mojdeh; Banga, Ramandeep; Anand, Sury

doi:10.14309/00000434-201010001-01450

Cited by 2 publications

(9 citation statements)

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“…In view of our preliminary findings, as well as similar findings reported by others recently at the ACG meeting, 5 and the effectiveness of erythromycin reported previously and substantiated by the meta-analysis by Barkun et al, we propose that erythromycin be considered preferentially over metoclopramide in selected patients in the setting of acute upper GI bleeding. Further randomized studies evaluating metoclopramide are needed before routine clinical use in the setting of acute GI bleeding can be recommended.…”

supporting

confidence: 91%

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

Daram

Garretson

2011

Gastrointestinal Endoscopy

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supporting

confidence: 91%

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

Daram

Garretson

2011

Gastrointestinal Endoscopy

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“…Twenty‐eight studies (65%) 38,53,59,61,68,72–75,78–82,87–91,93,97,98,106,107,109,110,112,114 reported patient‐centred outcomes including hospital LOS, mortality, surgical complications, infections, need for surgery and readmission rate.…”

Section: Resultsmentioning

confidence: 99%

“…[99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114] Nine studies (7%) were only available in the form of a conference abstract; seven clinical trials and two observational studies. [88][89][90][91][92][93]96,100,107 Four authors were contacted for full articles, one author responded. The main reasons for exclusion were ineligible study design (n = 217), which included literature reviews and case reports, and ineligible outcome(s) (n = 37), primarily studies assessing GI tube placement.…”

Section: Resultsmentioning

confidence: 99%

“…In the non‐ICU setting, five groups of different indications were studied, with the majority investigating the effect of prokinetic agents before endoscopy to improve visualisation, 16 studies (37%), 68,71–73,88–91,93,96,103–107,114 followed by recovery of bowel dysfunction postoperatively ( n = 10, 24%) 74,75,78–80,82,84,98,110,112 and prevention of aspiration during anaesthesia ( n = 8, 19%) 58–60,62–66 (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…c Only available in some Asian countries. d Only approved by the US Food and Drug Administration in the treatment of chronic constipation.117 Non-ICU settingThe most studied outcome in the non-ICU setting was the quality of the endoscopic procedure such as ability to identify source of bleeding, rate of complications, quality of visualisation and duration of endoscopy (37%) 68,[71][72][73][88][89][90][91]93,96,[103][104][105][106][107]114. This was followed by gastric emptying (28%) 58-60,62-66,79,86,87,94 and recovery of bowelF I G U R E 3 (A) ICU outcomes.…”

mentioning

confidence: 99%

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Use of prokinetic agents in hospitalised adult patients: A scoping review

Crone

Møller

Bækgaard

et al. 2023

Acta Anaesthesiol Scand

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Background: Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this scoping review, we aimed to systematically describe the body of evidence on the use of prokinetic agents in hospitalised patients. We hypothesised, that the body of evidence would be limited and derive from heterogeneous populations. Methods: We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. We searched Medline, Embase, Epistemonikos and the Cochrane Library for studies assessing the use of prokinetic agents on any indication and outcome in adult hospitalised patients. We used a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. Results:We included 102 studies with a total of 8830 patients. Eighty-six studies were clinical trials (84%), and 52 (60%) of these were conducted in the intensive care unit, with feeding intolerance as the main indication. In the non-intensive care setting the indications were wider; most studies assessed use of prokinetic agents before gastroscopy to improve visualisation. The most studied prokinetic agent was metoclopramide (49% of studies) followed by erythromycin (31%). In total 147 outcomes were assessed with only 67% of the included studies assessing patient-centred outcomes, and with gastric emptying as the most frequently reported outcome. Overall, the data provided no firm evidence on the balance between the desirable and undesirable effects of prokinetic agents. Conclusions:In this scoping review, we found that the studies addressing prokinetic agents in hospitalised adults had considerable variations in indications, drugs and outcomes assessed, and that the certainty of evidence was judged to be low to very low.

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Pre Endoscopy Use of Prokinetic Agent, Metoclopramide, to Influence Outcome in Upper GI Bleeding. Is There Evidence to Support Its Use?

Cited by 2 publications

References 0 publications

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

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

Use of prokinetic agents in hospitalised adult patients: A scoping review

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