The use of pre-endoscopic metoclopramide in patients with upper gastrointestinal bleeding: a systematic review and meta-analysis.

Abstract

Introduction: Upper gastrointestinal bleeding (UGIB) is a critical condition with an incidence of 80-150 cases per 100 000 annually and a mortality rate of 2-15%. Endoscopy is crucial for diagnosis and treatment. Prokinetic agents like metoclopramide are studied for their potential to improve visualization by promoting gastric motility. This meta-analysis evaluates the efficacy of intravenous metoclopramide in enhancing endoscopic visualization and clinical outcomes in UGIB patients.

Materials and methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review and meta-analysis using PubMed, Embase, Cochrane Library, and Scopus up to July 2024. We included randomized controlled trials involving UGIB patients who received intravenous metoclopramide vs placebo. Primary outcome was endoscopy visualization score (EMV). Meta-analysis was conducted using RevMan 5.4. This review was registered in PROSPERO RD42024552979.

Results: Five studies with 515 patients were included. The pooled analysis for overall EMV scores indicated significant improvement in metoclopramide group [standardized mean difference 0.47 (95% confidence interval, CI: 0.12-0.82)]. Repeat endoscopy showed no significant difference 0.70 (95% CI: 0.38-1.29). The mean difference for hospital stay was minimal and not significant [mean difference -0.06 (95% CI: -0.24 to 0.12)]. The mean number of red blood cell transfusions was slightly higher but not significant [mean difference 0.04 (95% CI: -0.14 to 0.22)].

Conclusion: Intravenous metoclopramide before endoscopy in UGIB patients improved EMV scores, while the other clinical outcomes were not significant. These findings suggest potential benefits of metoclopramide in UGIB, highlighting the need for further research with larger studies to confirm its effectiveness.