P0917 - POSTER WITHDRAWN

Mohamed Ezz, MBBCh¹, Ammar Dawwa, MBBS², Osama Barakat, MD³, Ahmed Farid Gadelmawla, MD⁴, Mohamedhen Vall Nounou, MD⁵, Abdusalam Alarabei, MSc⁶, Omar Khasawneh, MD⁷, Tuğba Saka, MD⁸, Sana Rabeeah, MD⁹, Mohammed Abu-Rumaileh, MD⁹, Bisher Sawaf, MD¹⁰, Muhammed Elhadi, MD¹¹
1Tanta University, Tanta, Al Qahirah, Egypt; 2Tishreen university, Latakia, Al Ladhiqiyah, Syria; 3University of Aleppo, Halab, Halab, Syria; 4Menoufia University, Menoufia, Al Minufiyah, Egypt; 5University of Nouakchott Al Aasrya, Nouakchott, Nouakchott, Mauritania; 6Universiti Putra, Putrajaya, Putrajaya, Malaysia; 7Jordan University of Science and Technology, Irbid, Irbid, Jordan; 8istinye university, Istanbul, Istanbul, Turkey; 9The University of Toledo, Toledo, OH; 10University of Toledo Medical Center, Toledo, OH; 11College of Medicine, Korea University, Seongbuk, Seoul-t'ukpyolsi, Republic of Korea

Introduction: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition with an annual incidence of 80–150 cases per 100,000 individuals and a mortality rate ranging from 2% to 15%. Timely endoscopy is vital for both diagnosis and treatment, yet its effectiveness hinges on optimal mucosal visualization. Prokinetic agents such as erythromycin and metoclopramide are commonly administered prior to endoscopy to enhance visualization. Although several meta-analyses have evaluated these agents separately, a direct comparison using network meta-analysis (NMA) has not been conducted.

Methods: A systematic search of major databases identified randomized controlled trials (RCTs) assessing the efficacy of prokinetics before endoscopy in patients with acute UGIB. Study selection was performed via Covidence. An NMA was conducted using the Netmeta package in R Studio (version 4.4.2), evaluating outcomes including adequacy of visualization, need for repeat endoscopy, hospital length of stay, endoscopy duration, blood transfusion, rebleeding, and mortality. Results were reported as odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Surface under the cumulative ranking curve (SUCRA) values were used for treatment ranking.

Results: Eleven RCTs comprising 1,155 patients were included. Comparisons involved metoclopramide, erythromycin (alone or with nasogastric lavage [NGL]), NGL alone, and placebo as the reference. Erythromycin significantly increased the odds of adequate visualization (OR 4.07, 95% CI: 1.44–11.56; p = 0.0083; SUCRA = 0.80), reduced the need for repeat endoscopy (OR 0.35, 95% CI: 0.17–0.73; p = 0.0052; SUCRA = 0.83), and shortened hospital stay (MD –1.09 days, 95% CI: –2.14 to –0.04; p = 0.0411; SUCRA = 0.94). No significant differences were found among interventions regarding endoscopy duration, transfusion, rebleeding, or mortality.

Discussion: Erythromycin demonstrates clinically relevant benefits in enhancing visualization and reducing both repeat endoscopy and hospitalization, particularly in patients with high gastric content or delayed emptying. In contrast, the role of metoclopramide remains uncertain, warranting further high-quality RCTs.


Disclosures:


Mohamed Ezz, MBBCh¹, Ammar Dawwa, MBBS², Osama Barakat, MD³, Ahmed Farid Gadelmawla, MD⁴, Mohamedhen Vall Nounou, MD⁵, Abdusalam Alarabei, MSc⁶, Omar Khasawneh, MD⁷, Tuğba Saka, MD⁸, Sana Rabeeah, MD⁹, Mohammed Abu-Rumaileh, MD⁹, Bisher Sawaf, MD¹⁰, Muhammed Elhadi, MD¹¹. P0917 - POSTER WITHDRAWN, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.