THE USE OF METACLOPROMIDE PRIOR TO ENDOSCOPY IN CASES OF UGI BLEED - A SYSTEMATIC REVIEW

Abstract

Background: Upper Gastrointestinal (UGI) bleeding is a critical clinical condition requiring timely and effective endoscopic evaluation for diagnosis and management. Visualization of the mucosa during endoscopy is often impaired due to retained blood and gastric contents, complicating treatment. Metoclopramide, a prokinetic agent, has been proposed to improve gastric emptying and mucosal visualization prior to endoscopy. Aim: To systematically evaluate the efficacy and safety of metoclopramide administration prior to endoscopy in patients presenting with UGI bleeding. Methods: A comprehensive literature search was conducted to identify studies assessing metoclopramide use before endoscopy in UGI bleed cases. Twenty relevant studies were included, encompassing various outcome measures such as mucosal visualization, procedure time, gastric emptying, residual blood volume, need for repeat endoscopy, adverse effects, and procedural satisfaction. Data were extracted and analyzed for effect sizes, significance, and safety profiles. Results: Metoclopramide significantly improved mucosal visualization rates and visualization scores across multiple studies (e.g., OR 3.00, p=0.015; MD 0.6, p=0.002). Procedure times and gastric emptying or clearance times were consistently reduced (MD ranges -3.5 to -14.2 minutes, p<0.001). Residual gastric and blood volumes were lower in the metoclopramide groups (MD -12 to -13 ml, p≤0.002), facilitating better endoscopic access. The requirement for repeat endoscopy was reduced (OR 0.36, p=0.006). Safety analyses indicated no significant increase in adverse events or aspiration pneumonia rates. Patient and procedural satisfaction scores also improved with metoclopramide use. Conclusion: Pre-endoscopic administration of metoclopramide in UGI bleeding patients enhances mucosal visualization, reduces procedural duration, and decreases the need for repeat endoscopy without compromising safety. These findings support the incorporation of metoclopramide as a standard adjunct in the preparation for endoscopy in UGI bleed cases. However, further large-scale randomized trials are recommended to standardize protocols and confirm long-term outcomes.