Metoclopramide for migration of naso-enteral feeding tube

Silva Cda, Saconato H, Atallah ÁN

Published Online:

July 8, 2009

Metoclopramide enhanced the migration of naso-enteral tubes, but the results were not statistically significant. In clinical practice, clinicians should no longer use metoclopramide for this purpose, however, more randomised clinical trials should be performed with metoclopramide. People who are given metoclopramide may experience adverse reactions.

Abstract (click to read)

Background:

Enteral alimentation by feeding tube is a common and efficient method of providing nutritional support to hospitalized patients with insufficient oral intake, but adequate gastrointestinal function. The use of metoclopramide, a prokinetic agent, has been recommended to achieve transpyloric placement, but its efficacy is controversial.

Objectives:

To determine the effect of intravenous metoclopramide on transpyloric passage of the naso-enteral tube.

Search strategy:

Trials were identified by searching MEDLINE 1996 to November 2008, EMBASE 1988 to November 2008, LILACS 2005 to November 2008, the Cochrane Controlled Trials Register, and The Cochrane Library (Issue 4, Year 2008) We did not confine our search to English language publications. Searches in all databases were updated in January 2005 update and November 2008. No new studies were found in 2008.

Selection criteria:

Types of participants: Adults needing enteral nutrition.
Types of intervention: Intravenous or intramuscular metoclopramide compared to placebo or no intervention.
Types of studies: Randomised controlled trials.
Types of outcome measures: The success of migration of transpyloric intubation.

Data collection and analysis:

The reviewers evaluated the allocation concealment, which was classified as adequate, uncertain or inadequate. Two reviewers extracted data independently. All analyses were performed according to the intention-to-treat method.

Main results:

Four studies were included and analysed. There was no statistically significant difference between intravenous or intramuscular metoclopramide administered to promote tube migration (OR 0.65, 95% CI 0.33 to 1.28). Intravenous metoclopramide 10 mg (OR 0.68, 95% CI 0.37 to 1.23) and 20 mg (OR 0.27, 95% CI 0.01 to 10.83) were equally ineffective in facilitating transpyloric intubation.

Authors' conclusions:

Metoclopramide enhanced the migration of naso-enteral tubes, but the results did not reach conventional statistical significance. The reasons may include: small studies, underpowered, varying doses, etc. In clinical practice, clinicians should no longer use metoclopramide for this purpose. However, more randomised clinical trials should be performed with a significant sample size, administering metoclopramide or not. The use of metoclopramide may include adverse reactions, such as depression, high blood pressure, decrease of libido, headache, skin rash, fatigue, fever, hyperactivity, insomnia, nausea, sedation, drowsiness, agitation, extrapyramidal reactions (impaired speech or impaired swallowing, unsteady gait, inflexibility of upper and lower members, tremor).

This record should be cited as:

Silva Cda, Saconato H, Atallah ÁN. Metoclopramide for migration of naso-enteral tube. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD003353. DOI: 10.1002/14651858.CD003353

Assessed as up to date:

December 24, 2008

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Primary Review Group:

Upper Gastrointestinal and Pancreatic Diseases Group

Health topics:

Gastroenterology > Gastric feeding

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Independent high-quality evidence for health care decision making

Metoclopramide for migration of naso-enteral feeding tube

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