THE EFFICACY OF METOCLOPRAMIDE OF GASTRIC VISUALIZATION BY ENDOSCOPY IN PATEINTS WITH ACTIVE UPPER GASTROINTESTINAL BLEEDING: DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL

Background: The 2021 ACG Guidelines suggested an infusion of intravenous (IV) erythromycin before endoscopy in patients with upper gastrointestinal bleeding (UGIB) as it improved gastric visualization during endoscopy and reduced in need for repeat endoscopy. However, IV erythromycin is not widely available. Evidence assessing IV metoclopramide, which is more accessible drug, is scant especially in patient with “active” UGIB. This study aimed to evaluate the efficacy of metoclopramide for gastric visualization in patients with active UGIB.
Methods: This double-blind, double center, randomized controlled trial study was conducted between April 2021 and October 2022. Patients with active UGIB (defined by either hematemesis or the presence of blood in nasogastric tube) were enrolled. We excluded patients with previous diagnosis of esophageal, duodenal, or gastric cancer or who had a gastric lavage of more than 50 mL. The included patients were randomly assigned to either metoclopramide or placebo in a 1:1 concealed allocation. The primary outcome was clear stomach which defined by endoscopic visualized gastric scores (EVS) 6 or more (total 8). The secondary outcomes included mean difference of EVS, duration of EGD, immediate hemostasis, need for a second look EGD, units of blood transfusion, length of hospital stay, and 30-day rebleeding rate.
Results: Sixty-eight eligible patients with active UGIB were randomized equally. Then, 4 patients were excluded due to protocol violation. Finally, 64 patients (metoclopramide 31, placebo 33) were analyzed. The baseline characteristics were not different between 2 groups. The Percentage of patient with clear stomach in the metoclopramide and placebo group was 77.4 % and 63.6% (p=0.22), respectively. The mean EVS was not different between two groups (6.6 vs 6.2, mean difference -0.4; p=0.37). The other secondary outcomes were not different between two assigned groups. In non-esophageal lesions subgroup analysis, the percentage of patient with clear stomach was significantly higher in metoclopramide compared to placebo group (88.9 % vs 57.9%, p=0.038)
Conclusion: Metoclopramide did not improve endoscopic gastric visualization in overall active UGIB lesions but significantly increased the clear stomach rate of those patients with non-esophageal lesions.