Impact of intravenous azithromycin on endoscopic preparation in acute upper gastrointestinal bleeding: Preliminary results from the CLEAN-AZ Study

Aims Poor visibility at endoscopy for upper gastrointestinal (UGI) bleeding increases the need for re-evaluation, and may be associated with higher morbidity, mortality, and costs. Current guidelines recommend prokinetic agents before endoscopy to enhance visibility and reduce the need for reintervention. This study aims to assess the efficacy and safety of intravenous azithromycin as a pre-endoscopic preparation in patients with acute UGI bleeding [1] [2] [3] [4].

Methods This is an unplanned intermediary analysis of CLEAN AZ (NCT06077916), a prospective, multicenter, randomized, double-blind, placebo-controlled trial conducted across multiple hospitals in Romania. Adult patients admitted with acute bleeding within 12 hours of onset, requiring upper gastrointestinal endoscopy, were randomized to either 500 mg of intravenous azithromycin (AZT) or saline. The primary outcomes are: quality of gastrointestinal visualization using the Toronto Upper Gastrointestinal Cleaning Score, and the need for repeat endoscopic evaluation. Secondary outcomes include the Toronto score for each gastric segment, hospital length of stay, blood transfusion requirements, adverse events, procedure duration, and endoscopist satisfaction with visibility during the procedure.

Results A total of 151 patients (mean age 64.3 years; 64.3% male) were included in this analysis, with a mean Glasgow-Blatchford score of 12.25. The mean Toronto score was similar between groups (9.58 in AZT compared to 9.02 in controls (p=0.33). Repeat procedures were deemed necessary in 14.81% of cases for the AZT group versus 21.56% for controls (p=0.37) and the mean hospital length of stay was 4.37 days for the AZT versus 5.47 days for controls (p=0.06). No significant differences in adverse events were observed between the two groups. The endoscopists' satisfaction score on a 5-step scale was significantly higher for the AZT group (4.26 vs.3.67 (p<0.01)).

Conclusions Preliminary results from this study suggest higher satisfaction with visibility during endoscopy for acute upper GI in patients receiving preprocedural AZT but non-significant differences in Toronto scores or length of hospitalization.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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