Resumen

PINO, Hugo et al. Metoclopramida mejora la calidad de la endoscopia digestiva superior en paciente con hemorragia digestiva superior activa. Gen [online]. 2011, vol.65, n.4, pp.318-321. ISSN 0016-3503.

Active upper gastrointestinal bleeding (AUGIB) is known as a frecuent cause of admission, is estimated to be 50 to 150 per 100,00 each year and it is associated with a significant mortality. There is evidence that suggest that prompt Upper Digestive Endoscopy (UDE) assessment in patients with upper gastrointestinal bleeding is safe and effective, however, in patients with active or recent bleeding the quality of endoscopic examination may be limited by the presence of clots and residual blood, especially in gastric fundus. Recent data suggest that another therapeutic measures as intravenous erythromycin and metoclopramide improve endoscopic visualization in patients with AUGIB, however, few studies confirm these information. Objetive: The aim of this study was to determine the utility of intravenous metoclopramide to improve upper digestive endoscopy quality in patients with AUGIB preventing the need for additional endoscopy attempts, surgery, blood transfusions, time of hospitalization and mortality. Methods: A transversal, randomized prospective study was developed between January and May 2010 at the Gastroenterology department of Dr. Miguel Pérez Carreño Hospital. All patients with clinical evidence of AUGIB were included; the symptoms must be assessed in the first 12 hours, and all of them must be over 18 year old. The subjects were divided into two groups: group A were people with upper gastrointestinal bleeding who received metoclopramide (10 mg) 30 to 40 minutes before UDE and group B did not receive metoclopramide before UDE. They were randomly chosen and compared. Upper digestive endoscopy was performed within the first six hours of admission. Exclusion criteria were: Known sensitivity or intolerance to metoclopramide, altered state of consciousness, pregnancy, lactancy and previous gastric lavage. Results: There were 44 patients (25 males - 19 females), of which 22 received intravenous metoclopramide. Twenty two patients did not receive promotility agents before the UDE. In group A, the cause of bleeding was identified during the first endoscopy in 17 patients, needing additional endoscopic assessment y 5 patients. In group B 12 patients were diagnosed during the first endoscopy, and 10 patients needed a second look to identify the cause of bleeding. The need for transfusion therapy was also assessed. Thirteen (13) patients in group A needed at least one unit of blood and 15 patients in group B received blood units. The number of patients who received more than 3 units of blood was 6 in group A and 9 in group B. Only one patient in each group needed surgery as treatment of upper gastrointestinal bleeding. The mean time of hospitalization was 6,09 days in group A and 6,77 in group B. Conclusions: The use of metoclopramide prior upper digestive endoscopy improves endoscopic visualization and facilitates the determination of the cause of bleeding as well as prevent the need for additional endoscopic attempts. However there wasn´t important decrease in the number of days of hospitalization. Metoclopramide can be considered as adjuvant treatment in the endoscopic management of patients with acute upper gastrointestinal bleeding.

Palabras clave : Metoclopramida; Active upper gastrointestinal bleeding; Upper Digestive Endoscopy.