Prokinetics Infusion Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding: A Randomized, Controlled, Double-Blind &amp; Placebo-Controlled Trial

Habashi, Samir L.; Lambiase, Louis; Kottoor, Ravi

doi:10.14309/00000434-200709002-01114

Cited by 10 publications

(18 citation statements)

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“…Of the remaining 28 articles and abstracts, seven RCTs from 2002 to 2011 were identified and included in the analysis ( N = 558) with varying locations (Switzerland, Poland, Saudi Arabia, United States, and three studies from France). [78910111213] The mean age ranged from 56 to 64.5. The details of the included studies are demonstrated in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…[78910111213] Gastric mucosa was adequately visualized in 209 of 278 patients (75%) in the erythromycin group compared with 147 of 280 (53%) in the no erythromycin group. Erythromycin infusion before endoscopy in UGIB demonstrated a statistically significant improvement in visualization of the gastric mucosa [OR 3.43; 95% confidence interval (CI): 1.81 to 6.50, P < 0.01] as compared with no erythromycin [Figure 2].…”

Section: Resultsmentioning

confidence: 99%

“…and Habashi et al ., demonstrated no difference between those patients receiving erythromycin and those that do not. [1113] Even more controversial, second-look endoscopy and duration of procedure were significantly reduced in only three studies[8912] and two studies,[910] respectively. Similarly, hospital stay was significantly reduced in only one RCT.…”

Section: Discussionmentioning

confidence: 99%

“…[78910111213] In addition, three meta-analyses have been performed examining the use of prokinetics with UGIB with varying results. [141516] To evaluate further, we performed a meta-analysis with multiple recent studies comparing the efficacy of erythromycin infusion before endoscopy in acute UGIB.…”

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confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…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 ].…”

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

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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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Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage

Adão

Góis

Pacheco

et al. 2023

Cochrane Database of Systematic Reviews

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Prokinetics Infusion Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding: A Randomized, Controlled, Double-Blind & Placebo-Controlled Trial

Cited by 10 publications

References 0 publications

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

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

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

Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage

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