S654 Comparative Analysis of Pre-endoscopy Intravenous Erythromycin versus Nasogastric Lavage and Combination of Both in Acute Upper GI Bleeding: A Systemic Review and Meta-Analysis

Abstract

Introduction: The diagnostic and therapeutic value of EGD in patients with acute UGIB is often limited by the presence of residual blood or clots. Prokinetic agents such as erythromycin or metoclopramide, or a nasogastric (NG) lavage are utilized to improve visualization upper GI tract. We conducted a systemic review and meta-analysis to find which is superior to achieve a satisfactory gastric visualization using either IV erythromycin or NG gastric lavage, or both Methods: We conducted a systematic search of the PubMed database from inception through May-2016 for studies comparing erythromycin, nasogastric lavage, and a combination of both in acute UGIB. Utilized terms were either “erythromycin”, “nasogastric lavage, or NG lavage and erythromycin”, “acute UGIB”. The primary endpoint was satisfactory stomach visualization (SSV) and secondary endpoints were identified as the frequency of repeat endoscopy, units of PRBC transfused, duration of endoscopy in minutes, mortality at 24 hours, and rebleeding rate. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The random-effects model was used for all variables, and publication bias was assessed using Egger’s test Results: Five randomized controlled trials and prospective studies published between 2002 and 2016, with a total of 541 patients, were included in our analysis. The patient’s pool presented with hematemesis or melena, whether it was variceal or non-variceal bleeding. We identified IV erythromycin to be superior to NG lavage alone regarding SSV with relative ratio of 1.338 (95% CI 1.006 to 1.780) (I2=67.984%), no difference between IV erythromycin alone versus a combination of IV erythromycin and NG lavage regarding the same primary endpoint with the relative ratio of 0.971 (95% CI 0.887 to 1.063) (I2=0.000%). We also identified no significant difference between intravenous erythromycin and nasogastric lavage alone regarding secondary endpoints as mentioned above with relative ratios of 0.713 (95% CI 0.434 to 1.171) (I2=21.960%), 0.762 (95% CI 0.303 to 1.920) (I2=0.000%), 1.052 (95% CI 0.778 to 1.424) (I2=0.000%), 1.482 (95% CI 0.254 to 8.643) (I2=0.000%) and 0.776 (95% CI 0.301 to 2.004) (I2=0.000%) respectively Conclusion: Our results suggest that IV erythromycin alone is superior to NG lavage alone and a combination of IV erythromycin and NG lavage in acute UGIB Using IV erythromycin alone has better outcomes regarding satisfactory stomach visualization and can enhance the quality of upper GI tract preparation.