title: Administration of erythromycin before endoscopy in upper gastrointestinal bleeding: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Erythromycin infusion before endoscopy in upper gastrointestinal bleeding (UGIB) has been hypothesized to aid in visualization and reduce the need for second-look endoscopy; however, the results have been controversial. To evaluate further, we performed a meta-analysis comparing the efficacy of erythromycin infusion before endoscopy in acute UGIB.
  
  
  METHODS
  Multiple databases were searched (March 2013). Only randomized controlled trials were included in the analysis. A meta-analysis for the effect of erythromycin or no erythromycin before endoscopy in UGIB were analyzed by calculating pooled estimates of primary (visualization of gastric mucosa and need for second endoscopy) and secondary (units of blood transfused, length of hospital stay, duration of the procedure) outcomes. Statistical analysis was performed using RevMan 5.1 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration).
  
  
  RESULTS
  Six studies (N = 558) met the inclusion criteria. Erythromycin infusion before endoscopy in UGIB demonstrated a statistically significant improvement in visualization of the gastric mucosa [odds ratio (OR) 3.43; 95% confidence interval (CI): 1.81 to 6.50, P < 0.01] compared with no erythromycin. In addition, erythromycin infusion before endoscopy resulted in a statistically significant decrease in the need for a second endoscopy (OR 0.47; 95% CI: 0.26 to 0.83, P = 0.01), units of blood transfused (WMD - 0.41; 95% CI: -0.82 to -0.01, P = 0.04), and the duration of hospital stay (WMD - 1.51; 95% CI: -2.45 to -0.56, P < 0.01).
  
  
  CONCLUSIONS
  Erythromycin infusion before endoscopy in patients with UGIB significantly improves visualization of gastric mucosa while decreasing the need for a second endoscopy, units of blood transfused, and duration of hospital stay.
authors.affiliation: Division of Gastroenterology and Hepatology, CE405, DC 043.00, University of Missouri Health Sciences Center, Five Hospital Drive, Columbia, MO 65212, USA.
authors.forename: Shoba
authors.initials: S
authors.lastname: Theivanayagam
authors.forename: Roxanne G
authors.initials: RG
authors.lastname: Lim
authors.forename: William J
authors.initials: WJ
authors.lastname: Cobell
authors.forename: Jayashree T
authors.initials: JT
authors.lastname: Gowda
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Matteson
authors.forename: Abhishek
authors.initials: A
authors.lastname: Choudhary
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
mesh_terms: D019072:Antibiotic Prophylaxis; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000473:pathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D024162:Second-Look Surgery / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D004917:Erythromycin
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