Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review
نویسندگان
چکیده
BACKGROUND In 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. METHODS After 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. RESULTS Eight 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. CONCLUSION Pre-endoscopic erythromycin administration in UGIB patients significantly improves gastric mucosa visualization while reducing length of hospital stay and the need for second-look endoscopy.
منابع مشابه
Meta-analysis: erythromycin before endoscopy for acute upper gastrointestinal bleeding.
BACKGROUND Studies evaluating the effect of erythromycin on patients with acute upper gastrointestinal bleeding (UGIB) had been reported, but the results were inconclusive. AIMS To compare erythromycin with control in patients with acute UGIB by performing a meta-analysis. METHODS Electronic databases including PubMed, EMBASE and the Cochrane Library, Science Citation Index, were searched t...
متن کاملSystematic review: tranexamic acid for upper gastrointestinal bleeding.
BACKGROUND Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE and Science Citation Index were combined. Intention-to-treat random effect meta-analyses were performe...
متن کاملMeta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review.
BACKGROUND Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. AIM To assess the benefits and harms of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding by pe...
متن کاملA summary of recent recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding.
Recommendations in managing patients with nonvariceal upper gastrointestinal bleeding were recently updated, addressing resuscitation, risk assessment and pre-endoscopic care, endoscopy, pharmacotherapy, and secondary prophylaxis. Initial adequate resuscitation and risk stratification using validated scales remain critical. Intravenous erythromycin improves visualization when likely to find blo...
متن کامل