Evidence map›Paper›PMID 41911096›Full record

SynthesisDigestive diseases (Basel, Switzerland)2026

Comparative Effectiveness of Prokinetic Agents with or without Nasogastric Lavage for Improving Endoscopic Visualization in Upper Gastrointestinal Bleeding: A Systematic Review and Network Meta-Analysis.

Laith Altawil, Mohammad Al Hayek, Mohamedhen Vall Nounou, Ammar Dawwa, Osama Barakat, Bisher Sawaf, Abdusalam A Alarabei, Omar Khasawneh, Mohamed R Ezz, Tugba Saka and 3 more

Abstract readNetwork Meta-AnalysisSystematic ReviewComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Digestive diseases (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Laith AltawilFaculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Mohammad Al HayekFaculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Mohamedhen Vall NounouFaculty of Medicine, University of Nouakchott Al Aasrya, Nouakchott, Mauritania.
Ammar DawwaFaculty of Medicine, Latakia University, Latakia, Syrian Arab Republic.
Osama BarakatFaculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic.
Bisher SawafDepartment of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.
Abdusalam A AlarabeiFaculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
Omar KhasawnehFaculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Mohamed R EzzFaculty of Medicine, Tanta University, Tanta, Egypt.
Tugba SakaFaculty of Medicine, İstinye University, Istanbul, Turkey.
Mulham AlomInternal Medicine, Southern Illinois University School of Medicine, Chicago, Illinois, USA.
Muhammed ElhadiCollege of Medicine, Korea University, Seoul, Republic of Korea, muhammed-elhadi@korea.ac.kr.
Yaseen AlastalDivision of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

<p>Introduction: Upper gastrointestinal bleeding (UGIB) is a common emergency where poor endoscopic visualization due to retained blood and clots hampers diagnosis and therapy. Prokinetic agents and nasogastric (NG) lavage are used to improve visualization, but their comparative effectiveness remains unclear. This study evaluated the comparative efficacy of prokinetics - with or without NG lavage - versus NG lavage alone, prokinetics alone, or placebo in improving endoscopic visualization in UGIB.

methodsA systematic search of five databases up to April 2025 identified randomized controlled trials (RCTs) comparing erythromycin, metoclopramide, NG lavage, or combinations against placebo. Network meta-analysis using a frequentist random-effects model assessed the primary outcome of adequate visualization. Secondary outcomes included visualization score, endoscopy duration, and blood transfusion units within 24 h. Risk ratios (RRs) and standardized mean differences (SMDs) were calculated. Treatments were ranked using Surface Under the Cumulative Ranking curve (SUCRA).

resultsA total of 10 RCTs (1,083 patients) were included: erythromycin (n = 226), erythromycin+NG lavage (n = 186), metoclopramide (n = 34), metoclopramide+NG lavage (n = 143), NG lavage alone (n = 333), and placebo (n = 161). Erythromycin + NG lavage ranked highest for adequate visualization (RR: 2.49; 95% CI: 1.57-3.95; SUCRA: 92%), followed by erythromycin (RR: 2.24; 95% CI: 1.56-3.21) and NG lavage (RR: 1.70; 95% CI: 1.06-2.73). Erythromycin improved visualization score (SMD: 0.86; 95% CI: 0.36-1.36; SUCRA: 73%). No significant differences were found for endoscopy duration or transfusion units.

conclusionErythromycin, particularly when combined with NG lavage, appears most effective for improving endoscopic visualization in UGIB. However, this procedural benefit did not translate into reductions in endoscopy duration or 24-h transfusion requirements, and the impact on other patient-centered outcomes remains uncertain. </p>.

Indexed as

Endoscopy, GastrointestinalGastric LavageGastrointestinal AgentsGastrointestinal HemorrhageErythromycinHumansMetoclopramideRandomized Controlled Trials as TopicTreatment OutcomeErythromycinGastrointestinal AgentsMetoclopramideEndoscopic visualizationErythromycinMetoclopramideNasogastric lavageNetwork meta-analysisProkinetic agentsUpper gastrointestinal bleeding

Identifiers

PMID41911096
PMCPMC13258244

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.