IDDF2022-ABS-0021 A multicenter, randomized, double-blind, controlled trial of effects of using intravenous metoclopramide to increase mucosal visualization during endoscopy in patients with acute upper gastrointestinal bleeding

Manupeeraphant, Paveeyada; Techathuvanan, Karjpong; Wanichagool, Dhanusorn; Songlin, Thaphat; Thanathanee, Piyarat

doi:10.1136/gutjnl-2022-iddf.143

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“…The previous abstract provided evidence of the efficacy of metoclopramide in treating EMV in a limited sample size. However, it did not specifically investigate the impact on active fresh blood or the etiologic subgroup 19 . Therefore, we decided to collect a study on large population of UGIH from multiple centers to evaluate the effect of metoclopramide in mucosal visualization by calibrating the grading points of visualization among all endoscopists using the Modified Avgerinos score.…”

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confidence: 99%

Intravenous metoclopramide for increasing endoscopic mucosal visualization in patients with acute upper gastrointestinal bleeding: a multicenter, randomized, double-blind, controlled trial

Manupeeraphant,

Wanichagool,

Songlin

et al. 2024

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Acute upper gastrointestinal hemorrhage (UGIH) is the most common emergency condition that requires rapid endoscopic treatment. This study aimed to evaluate the effects of pre-endoscopic intravenous metoclopramide on endoscopic mucosal visualization (EMV) in patients with acute UGIH. This was a multicenter, randomized, double-blind controlled trial of participants diagnosed with acute UGIH. All participants underwent esophagogastroduodenoscopy within 24 h. Participants were assigned to either the metoclopramide or placebo group. Modified Avgerinos scores were evaluated during endoscopy. In total, 284 out of 300 patients completed the per-protocol procedure. The mean age was 62.8 ± 14.3 years, and 67.6% were men. Metoclopramide group achieved a higher total EMV and gastric body EMV score than the other group (7.34 ± 1.1 vs 6.94 ± 1.6; P = 0.017 and 1.80 ± 0.4 vs 1.64 ± 0.6; P = 0.006, respectively). Success in identifying lesions was not different between the groups (96.5% in metoclopramide and 93.6% in placebo group; P = 0.26). In the metoclopramide group, those with active variceal bleeding compared with the control group demonstrated substantial improvements in gastric EMV (1.83 ± 0.4 vs 1.28 ± 0.8, P = 0.004), antral EMV (1.96 ± 0.2 vs 1.56 ± 0.6, P = 0.003), and total EMV score (7.48 ± 1.1 vs 6.2 ± 2.3, P = 0.02). Pre-endoscopic intravenous metoclopramide improved the quality of EMV in variceal etiologies of UGIH, which was especially prominent in those who had signs of active bleeding based on nasogastric tube assessment.Trial Registration: Trial was registered in Clinical Trials: TCTR 20210708004 (08/07/2021).

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Section: Discussionmentioning

confidence: 99%