Administration of Metoclopramide Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding: A Systematic Review and GRADE Meta-Analysis of Randomized Controlled Trials.

Abstract

Acute Upper Gastrointestinal Bleeding (UGIB) is a critical condition where endoscopy is often hindered by poor visibility. This meta-analysis assesses the safety and efficacy of metoclopramide as a pre-endoscopic aid to improve visualization. Databases including PubMed, Cochrane Library, ScienceDirect, and Google Scholar were searched from inception till October 2024. Review Manager 5.4.1 software was utilized to combine standard and weighted mean differences as well as risk ratios for continuous and dichotomous outcomes, respectively. Quality assessment was carried out by the Cochrane Risk of Bias Tool 2.0. Publication bias was assessed through funnel plots. GRADE assessment was conducted to determine the certainty of the evidence. The protocol of this review was registered on PROSPERO under the ID CRD42024569658. A total of eight studies were included, resulting in a pooling 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; I ² = 0%), Endoscopic Visualization Score Body (SMD = 0.25, 95% CI: [0.07, 0.42]; p = 0.006; I ² = 0%), Endoscopic Visualization Score Antrum (SMD = 0.23, 95% CI: [0.05, 0.40]; p = 0.01; I ² = 0%), and Endoscopic Visualization Score Total (SMD = 0.32, 95% CI: [0.15, 0.50]; p = 0.0003; I ² = 0%). Outcomes such as length of hospital stay, re-endoscopy, RBC transfusion units, second look endoscopy, duration of endoscopy, and mortality showed insignificant results. In conclusion, metoclopramide usage improved the endoscopic visualization, but it showed no significant results when evaluated for the secondary outcomes. However, there is a clear need for more full-length clinical trials demonstrating the safety and efficacy of metoclopramide to establish robust evidence.