High-dose metoclopramide versus placebo for gastroduodenal visualization during endoscopy in patients with acute upper gastrointestinal bleeding. A triple-blind, randomized clinical trial

INTRODUCTION AND AIMS: The usefulness of metoclopramide for improving endoscopic visualization in upper gastrointestinal bleeding (UGIB) is controversial. Our primary aim was to evaluate the utility of metoclopramide 20 mg/IV for endoscopic visualization in UGIB of ≤ 24 h. The need for a repeat endoscopy and length of hospital stay were also analyzed. MATERIALS AND METHODS: Patients were randomized 1:1 to receive placebo (group A) or metoclopramide 20 mg/IV (group B) and undergo endoscopy 30-120 min later. Demographics, etiology, and hospital stay were evaluated. The percentage of gastroduodenal visualization was assessed through the modified Avgerinos score. A blinded, experienced endoscopist reviewed the endoscopic recordings. RESULTS: Fifty patients, 27 men and 23 women, were included. Mean patient age was 60 years, and each group was made up of 25 patients. The time from admission to endoscopy in group A was 14:21 h (SD ± 5.35) and 14:54 h (SD ± 5.83) in group B (p = 0.83). The modified Avgerinos score was 7.00 (5.00-8.00) in group A and 7.00 (6.50-8.00) in group B (p = 0.282). The difference in the modified Avgerinos score was not statistically significant in the patients with variceal and ulcerous etiologies (p = 0.705 and p = 0.721, respectively). A repeat endoscopy was required in 3 group A patients and 4 group B patients (p = 0.684). Hospital stay for group A was 7.0 days (SD ± 3.08) and 7.32 days (SD ± 4.31) for group B (p = 0.764). CONCLUSIONS: Metoclopramide 20 mg/IV before endoscopy did not improve endoscopic visualization, the need for a repeat endoscopy, or length of hospital stay in patients with UGIB.