S1435 Administration of Metoclopramide Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Acute upper gastrointestinal bleeding (UGIB) is a medical emergency requiring prompt and effective management. While endoscopy is an effective diagnostic tool for UGIB, its effectiveness can be influenced by the quality of gastrointestinal visualization hindered by the bleeding. This meta-analysis aims to evaluate the safety and efficacy of metoclopramide, a pre-endoscopic drug proposed to enhance visual clarity, in patients with UGIB. Methods: PubMed, Cochrane Library, and ScienceDirect were searched from inception till October 2024. Risk ratios (RR), standardized mean differences (SMD), and mean differences (MD) were pooled under the random effects model using Review Manager software version 5.4.1 for dichotomous and continuous outcomes. The primary and secondary outcomes analyzed were endoscopic visualization score (EVS) for fundus, body, antrum, total EVS score, length of hospital stay, repeat endoscopy, second look endoscopy, duration of endoscopy, mortality and need for RBC transfusion. Quality assessment was done through the Cochrane RoB 2.0 tool and Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots and statistically through Egger’s regression test. Sensitivity analysis was conducted to investigate heterogeneity. Results: A total of 7 studies were included, resulting in a pooled analysis of 665 patients. Metoclopramide significantly increases the Endoscopic Visualization Score of the Fundus (SMD = 0.30, 95% CI: [0.12, 0.47]; P = 0.0008; I² = 0%), Endoscopic Visualization Score Body (SMD = 0.25, 95% CI: [0.07, 0.42]; P = 0.006; I² = 0%), Endoscopic Visualization Score Antrum (SMD = 0.23, 95% CI: [0.05, 0.40]; P = 0.01; I² = 0%), and Endoscopic Visualization Score Total (SMD = 0.32, 95% CI: [0.15, 0.50]; P = 0.0003; I² = 0%). Outcomes such as length of hospital stay (P = 0.73), re-endoscopy (P = 0.53), RBC transfusion units (P = 0.42), second look endoscopy(P = 0.44), duration of endoscopy (P = 0.82), and mortality (P = 0.86) showed insignificant results. Conclusion: In conclusion, metoclopramide usage improved the endoscopic visualization, but it showed no significant results when evaluated for the secondary outcomes. However, there is a definite need for more full-length clinical trials demonstrating the safety and efficacy of metoclopramide to establish robust evidence.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.039 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".