Rahman Rubayat, Nguyen Douglas L, Sohail Umair, Almashhrawi Ashraf A, Ashraf Imran, Puli Srinivas R, Bechtold Matthew L
Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA.
Gastroenterology and Hepatology, University of California-Irvine (Douglas L. Nguyen), USA.
Ann Gastroenterol. 2016 Jul-Sep;29(3):312-7. doi: 10.20524/aog.2016.0045. Epub 2016 May 20.
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.
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.
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.
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.
在上消化道出血（UGIB）患者中，内镜检查时充分的视野至关重要。在内镜检查前，已证明给予红霉素可增强这些患者的视野；然而，指南尚未完全采用这种做法。因此，我们针对该患者群体中给予红霉素这一问题进行了一项全面、最新的荟萃分析。
在检索多个数据库（2015年11月）后，纳入了比较UGIB患者在内镜检查前给予红霉素与不给予红霉素或安慰剂的成年受试者随机对照试验。计算使用比值比（OR）或均值差（MD）对可视胃黏膜充分性、二次内镜检查需求、操作持续时间、住院时间、输血量以及急诊手术需求的合并估计值。评估异质性和发表偏倚。
发现八项研究（n = 598）符合纳入标准。给予红霉素在可视胃黏膜充分性方面显示出统计学上的显著改善（OR 4.14；95% CI：2.01 - 8.53，P < 0.01），同时减少了二次内镜检查的需求（OR 0.51；95% CI：0.34 - 0.77，P < 0.01）和住院时间（MD -1.75；95% CI：-2.43至-1.06，P < 0.01）。操作持续时间（P = 0.2）、输血量（P = 0.08）和急诊手术需求（P = 0.88）无显著差异。
UGIB患者内镜检查前给予红霉素可显著改善胃黏膜视野，同时减少住院时间和二次内镜检查的需求。
