S1435 Administration of Metoclopramide Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Introduction: Acute upper gastrointestinal bleeding (UGIB) is a medical emergency requiring prompt and effective management. While endoscopy is an effective diagnostic tool for UGIB, its effectiveness can be influenced by the quality of gastrointestinal visualization hindered by the bleeding. This meta-analysis aims to evaluate the safety and efficacy of metoclopramide, a pre-endoscopic drug proposed to enhance visual clarity, in patients with UGIB. Methods: PubMed, Cochrane Library, and ScienceDirect were searched from inception till October 2024. Risk ratios (RR), standardized mean differences (SMD), and mean differences (MD) were pooled under the random effects model using Review Manager software version 5.4.1 for dichotomous and continuous outcomes. The primary and secondary outcomes analyzed were endoscopic visualization score (EVS) for fundus, body, antrum, total EVS score, length of hospital stay, repeat endoscopy, second look endoscopy, duration of endoscopy, mortality and need for RBC transfusion. Quality assessment was done through the Cochrane RoB 2.0 tool and Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots and statistically through Egger’s regression test. Sensitivity analysis was conducted to investigate heterogeneity. Results: A total of 7 studies were included, resulting in a pooled analysis of 665 patients. Metoclopramide significantly increases the Endoscopic Visualization Score of the Fundus (SMD = 0.30, 95% CI: [0.12, 0.47]; P = 0.0008; I² = 0%), Endoscopic Visualization Score Body (SMD = 0.25, 95% CI: [0.07, 0.42]; P = 0.006; I² = 0%), Endoscopic Visualization Score Antrum (SMD = 0.23, 95% CI: [0.05, 0.40]; P = 0.01; I² = 0%), and Endoscopic Visualization Score Total (SMD = 0.32, 95% CI: [0.15, 0.50]; P = 0.0003; I² = 0%). Outcomes such as length of hospital stay (P = 0.73), re-endoscopy (P = 0.53), RBC transfusion units (P = 0.42), second look endoscopy(P = 0.44), duration of endoscopy (P = 0.82), and mortality (P = 0.86) showed insignificant results. Conclusion: In conclusion, metoclopramide usage improved the endoscopic visualization, but it showed no significant results when evaluated for the secondary outcomes. However, there is a definite need for more full-length clinical trials demonstrating the safety and efficacy of metoclopramide to establish robust evidence.