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Poster Session D - Tuesday Morning

D0303 - Improving the Quality of Esophagogastroduodenoscopy Using Prokinetic in Upper Gastrointestinal Bleeding: A Network Meta-Analysis

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Hossein Haghbin, MD

Ascension Providence Southfield
Southfield, MI

Award: Presidential Poster Award

Hossein Haghbin, MD¹, Nuruddinkhodja Zakirkhodjaev, MD², Faiza Husain, MD³, Muhammad Aziz, MD⁴
¹Ascension Providence Southfield, Southfield, MI; ²Stony Brook University, Stony Brook, NY; ³University of Michigan, Ann Arbor, MI; ⁴University of Toledo College of Medicine, Toledo, OH

Introduction: Upper gastrointestinal bleeding (UGIB) usually requires esophagogastroduodenoscopy (EGD) for diagnosis and intervention but blood obscures the view. Prior studies have reported positive outcomes with erythromycin administration and nasogastric tube (NG) lavage. This network meta-analysis investigates the efficacy of these interventions.

Methods: We performed a systematic literature search of multiple databases (through March 2022) to include randomized controlled trials (RCTs) comparing different interventions in EGD for UGIB. Outcomes assessed included duration of endoscopy, length of hospital stay, mortality, need for repeat endoscopy, and blood transfusion. We also performed network meta-analysis of the measured outcomes. We used Open Meta Analyst (CEBM, University of Oxford, Oxford, United Kingdom) as the computing software.

Results: A total of 721 patients from 8 RCTs were included in our analysis (Table 1). The mean age (+/- standard deviation) and male ratio were 60 (+/- 3.1) years and 73.2%, respectively. Four intervention groups of erythromycin, placebo, NG lavage, and NG lavage + erythromycin were defined. All interventions had higher rates of empty stomach than placebo: erythromycin (RR: 2.24, CI: 1.57 – 3.20), NG lavage (RR: 1.70, CI: 1.06 - 2.72), and NG lavage with erythromycin (RR: 2.49, CI: 1.58 – 3.94). The need for second look endoscopy was significantly lower for erythromycin than placebo (RR: 0.42, CI: 0.22 – 0.83) while not different in NG lavage (RR: 0.70, CI: 0.27 – 1.79, p = 0.45), and NG lavage with erythromycin (RR: 0.46, CI: 0.18 – 1.18) compared to placebo. Overall mortality was not significantly different for erythromycin (RR: 0.61, CI: 0.18 – 2.02), NG lavage (RR: 0.61, CI: 0.14 – 2.67), or the combination of NG lavage with erythromycin (RR: 0.20, CI: 0.04 – 1.08) compared to placebo. Using the frequentist approach, the combination of NG lavage + erythromycin (92.2) was rated highest, followed by erythromycin (73.1) alone for higher rates of empty stomach. Mortality was lowest for the combination of NG lavage with erythromycin (97.06). Erythromycin alone was rated highest for lower need for PRBC transfusion (72.8) and mean endoscopy duration (66.0) (Figure 1).

Discussion: Erythromycin improved visualization at EGD, reduced requirements for blood transfusion and repeat EGD, and shortened hospital stay

Study, Year

Mean age, years (SD)

No. of Patients, N

Empty Stomach, N (%)

Second look Endoscopy, N (%)

Mortality, N (%)

Mean Duration, mins (SD)

Hospital Stay, days (SD)

Mean PRBC Transfusion, (SD)

Altraif, 2010

E: 62.3 (9.8)

P: 62.7 (14.7)

E: 53

P: 49

E: 23 (48.9%)

P: 10 (23.3%)

E: 2 (4.3%)

P: 4 (9.3%)

E: 4 (8.5%)

P: 6 (14%)

E: 19 (9.8)

P: 26 (13.4)

E: 3.4 (2.4)

P: 5.1 (2.9)

E: 3 (1.8)

P: 3.6 (2.8)

Ardakani, 2013

NG lavage: 62 (17)

NG lavage+ E: 61 (15)

NG lavage: 20

NG lavage+ E: 20

NG lavage: 5 (25%)

NG lavage + E: 20 (100%)

NG lavage: 20 (100%)

NG lavage + E: 9 (45%)

NG lavage: 1 (5%)

NG lavage + E: 0 (0%)

NG lavage: 31.7 (6.1)

NG lavage + E: 13.6 (2.7)

NG lavage: 5 (2)

NG lavage + E: 3 (1)

NG lavage: 5 (2)

NG lavage + E: 1 (1)

Carbonell, 2006

NG lavage: 57 (13.4)

NG lavage+ E: 59.3 (14.6)

NG lavage: 50

NG lavage + E: 50

NG lavage: 22 (44%)

NG lavage + E: 32 (65.3%)

NG lavage: 12 (24%)

NG lavage + E: 12 (24.5%)

NG lavage: 0 (0%)

NG lavage + E: 0 (0%)

NG lavage: 16 (8)

NG lavage + E: 18 (9)

NG lavage: 7.6 (6.1)

NG lavage + E: 7.5 (6)

NG lavage: 1.94 (2.9)

NG lavage + E: 1.34 (1.4)

Coffin, 2002

NG lavage: 58 (20)

NG lavage+ E: 56 (19)

NG lavage: 22

NG lavage + E: 19

NG lavage: 12 (54.5%)

NG lavage + E: 17 (89.5%)

NG lavage: 10 (45.5%)

NG lavage + E: 3 (15.8%)

NG lavage: 2 (9.1%)

NG lavage + E: 0 (0%)

NG lavage: NR

NG lavage + E: NR

NG lavage: 6.5 (1.7)

NG lavage + E: 5.8 (0.8)

NG lavage: 4.2 (1)

NG lavage + E: 3.4 (4)

Frossard, 2002

E: 59.2 (15)

P: 64.5 (16)

E: 51

P: 54

E: 42 (82.4%)

P: 18 (33.3%)

E: 6 (11.8%)

P: 17 (31.5%)

E: NR

P: NR

E: 13.7 (4.5)

P: 16.4 (7.8)

E: 10.2 (6.4)

P: 12.2 (8.7)

E: 1.9 (1.5)

P: 2.3 (1.7)

Na, 2017

NG lavage: 63 (12)

NG lavage+ E: 57 (15)

E: 60 (14)

NG lavage: 15

NG lavage + E: 14

E: 14

NG lavage: 9 (60.0%)

NG lavage + E: 13 (92.9%)

E: 13 (92.9%)

NG lavage: NR

NG lavage + E: NR

E: NR

NG lavage: 0 (0%)

NG lavage + E: 0 (0%)

E: 0 (0%)

NG lavage: 11 (8)

NG lavage + E: 14 (10)

E: 11 (4)

NG lavage: NR

NG lavage + E: NR

E: NR

NG lavage: 1.75 (0.83)

NG lavage + E: 1.75 (0.83)

E: 1 (0.6)

Pateron, 2011

NG lavage: 61 (15)

NG lavage+ E: 60 (17)

E: 61 (14)

NG lavage: 85

NG lavage + E: 84

E: 84

NG lavage: 68 (82.0%)

NG lavage + E: 69 (88.5%)

E: 69 (84.1%)

NG lavage: 20 (24.1%)

NG lavage + E: 17 (21.8%)

14 (17.1%)

NG lavage: 9 (10.8%)

NG lavage + E: 3 (3.8%)

E: 9 (11%)

NG lavage: 11.5 (2.3)

NG lavage + E: 14.5 (2.9)

E: 10.7 (2.6)

NG lavage: NR

NG lavage + E: NR

E: NR

NG lavage: 2 (1.7)

NG lavage + E: 2.4 (1.3)

E: 2 (1.2)

Shah, 2020

E: 53.13 (17.7)

P: 54.23 (15.8)

E: 30

P: 30

E: 25 (83.3%)

P: 12 (40%)

E: 4 (13.3%)

P: 8 (26.7%)

E: 0 (0%)

P: 0 (0%)

E: 15.5 (4.3)

P: 14.3 (3)

E: 5.2 (2.4)

P: 5.4 (2.8)

E: 1.37 (1.3)

P: 1.77 (1.6)

Table: Table 1: Outcomes for individual studies (E: Erythromycin, N: No. of patients, NG: Nasogastric tube, NR: Not reported, P: Placebo, PRBC: Packed red blood cell, SD: Standard deviation)

Disclosures:

Hossein Haghbin indicated no relevant financial relationships.

Nuruddinkhodja Zakirkhodjaev indicated no relevant financial relationships.

Faiza Husain indicated no relevant financial relationships.

Muhammad Aziz indicated no relevant financial relationships.

Hossein Haghbin, MD¹, Nuruddinkhodja Zakirkhodjaev, MD², Faiza Husain, MD³, Muhammad Aziz, MD⁴. D0303 - Improving the Quality of Esophagogastroduodenoscopy Using Prokinetic in Upper Gastrointestinal Bleeding: A Network Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.