Table 2_Role of prokinetic drugs prior to endoscopy in acute upper gastrointestinal bleeding: a systematic review and meta-analysis.docx

Because visualization scores were measured using different scales, this outcome was pooled using standardized mean difference (SMD). Certainty of evidence was assessed using GRADE.</p>Results<p>Ten randomized trials including 1,077 participants were included. Eight trials evaluated erythromycin and two evaluated metoclopramide.

Pre-endoscopic prokinetic therapy improved adequate gastric emptying or endoscopic visualization (OR 3.68, 95% CI 2.06–6.60; p < 0.0001; I² = 59.9%) and reduced repeat endoscopy (OR 0.54, 95% CI 0.37–0.79; p = 0.0015; I² = 20.8%). Continuous endoscopic visualization scores also favored prokinetic therapy when analyzed using SMD (SMD 0.47, 95% CI 0.21–0.72; p = 0.0003; I² = 62.1%). No clear benefit was demonstrated for mortality (OR 0.59, 95% CI 0.32–1.09), rebleeding (OR 1.12, 95% CI 0.64–1.97), blood transfusion requirement (MD −0.64 units, 95% CI −1.44 to 0.15), or endoscopy duration (MD −1.67 minutes, 95% CI −5.59 to 2.25) under random-effects models.

Length of hospital stay was shorter with prokinetic therapy (MD −1.30 days, 95% CI −2.11 to −0.49), although this outcome may be influenced by healthcare-system factors. Safety reporting was limited and inconsistent; no consistent serious safety signal was identified, but the trials were not powered to detect uncommon adverse events such as QT prolongation, arrhythmia, or extrapyramidal reactions.</p>Conclusion<p>Pre-endoscopic prokinetic therapy, supported mainly by erythromycin-based randomized evidence, improves gastric emptying/endoscopic visualization and probably reduces repeat endoscopy in adults with acute UGIB.

These findings should be interpreted primarily as procedural benefits rather than evidence of improved hard clinical outcomes. Evidence for metoclopramide remains limited and less consistent, and current data do not support a definitive class effect for all prokinetic drugs.</p>