Pre-endoscopy erythromycin versus metoclopramide for upper gastrointestinal bleeding: a systematic review and network...

Given the limited head-to-head trials comparing the outcomes of pre-endoscopy erythromycin and metoclopramide for upper gastrointestinal bleeding (UGIB), a network meta-analysis (NMA) and component NMA were conducted.

A comprehensive review of the Medline, Embase, and Cochrane databases was conducted for randomized controlled trials comparing pre-endoscopy erythromycin or metoclopramide for UGIB with or without gastric lavage (GL) to placebo and/or GL. The primary outcome was the adequate visualization of the mucosa. The secondary outcomes were endoscopy visualization score, endoscopy duration, diagnosis established at initial endoscopy, second-look endoscopy, blood transfusions, mortality, and duration of hospitalization.

A total of 16 studies (1,447 patients) were included. No significant differences were observed between erythromycin and metoclopramide in all the outcomes, but erythromycin had significantly better outcomes than the control group in terms of endoscopic visualization score (standardized mean difference, 0.58; 95% confidence interval [CI], 0.26-0.91), adequate mucosal visualization (risk ratio, 1.55; 95% CI, 1.18-2.04), second-look endoscopy, transfusion requirements, and duration of hospitalization. Component network meta-analysis revealed that erythromycin, but not metoclopramide or GL, provided significantly better endoscopic visualization than the placebo.

Erythromycin should be considered before UGIB endoscopy. The current data do not support the use of metoclopramide or GL.