title: Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review.
abstract: BACKGROUND
  In patients suffering from upper gastrointestinal bleeding (UGIB), adequate visualization is essential during endoscopy. Prior to endoscopy, erythromycin administration has been shown to enhance visualization in these patients; however, guidelines have not fully adopted this practice. Thus, we performed a comprehensive, up-to-date meta-analysis on the issue of erythromycin administration in this patient population.
  
  
  METHODS
  After searching multiple databases (November 2015), randomized controlled trials on adult subjects comparing administration of erythromycin before endoscopy in UGIB patients to no erythromycin or placebo were included. Pooled estimates of adequacy of gastric mucosa visualized, need for second endoscopy, duration of procedure, length of hospital stay, units of blood transfused, and need for emergent surgery using odds ratio (OR) or mean difference (MD) were calculated. Heterogeneity and publication bias were assessed.
  
  
  RESULTS
  Eight studies (n=598) were found to meet the inclusion criteria. Erythromycin administration showed statistically significant improvement in adequate gastric mucosa visualization (OR 4.14; 95% CI: 2.01-8.53, P<0.01) while reduced the need for a second-look endoscopy (OR 0.51; 95% CI: 0.34-0.77, P<0.01) and length of hospital stay (MD -1.75; 95% CI: -2.43 to -1.06, P<0.01). Duration of procedure (P=0.2), units of blood transfused (P=0.08), and need for emergent surgery (P=0.88) showed no significant differences.
  
  
  CONCLUSIONS
  Pre-endoscopic erythromycin administration in UGIB patients significantly improves gastric mucosa visualization while reducing length of hospital stay and the need for second-look endoscopy.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA.
authors.forename: Rubayat
authors.initials: R
authors.lastname: Rahman
authors.affiliation: Gastroenterology and Hepatology, University of California-Irvine (Douglas L. Nguyen), USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA.
authors.forename: Umair
authors.initials: U
authors.lastname: Sohail
authors.affiliation: Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA.
authors.forename: Ashraf A
authors.initials: AA
authors.lastname: Almashhrawi
authors.affiliation: Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA.
authors.forename: Imran
authors.initials: I
authors.lastname: Ashraf
authors.affiliation: Gastroenterology and Hepatology, University of Illinois-Peoria (Srinivas R. Puli), USA.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
authors.affiliation: Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
keywords: Erythromycin; bleeding; endoscopy