Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: a randomized clinical trial.
Delayed gastric emptying after esophagogastrectomy can pose a significant early postoperative problem. Because erythromycin, which stimulates the gastric antral and duodenal motilin receptor, has been shown to significantly increase gastric emptying in patients with diabetic gastroparesis, we decided to evaluate its effect on gastric emptying after esophagogastrectomy.


METHODS
Twenty-four patients (18 men and six women, age range 41 to 79 years, median 66 years) were randomized to receive either erythromycin lactobionate (200 mg in 50 ml normal saline solution intravenously) (n = 13) or placebo (50 ml normal saline solution intravenously (n = 11) 11 days after esophagogastrectomy (with pyloric drainage procedure). After erythromycin or placebo had been infused over a 15-minute period, patients ingested a solid meal (scrambled egg with bread) labeled with technetium 99m sulfur colloid (500 microCi) over approximately 15 minutes. Dynamic images of the stomach were then acquired over 90 minutes in the supine position by gamma imaging. Results were expressed as percentage of counts retained in the stomach (percent gastric retention) over time.


RESULTS
There were no side effects of erythromycin. In the placebo group, the mean percent of radiolabeled meal retained in the stomach after 90 minutes was 88%, which was significantly greater than in the erythromycin group, 37% (p < 0.001). In addition, analysis of covariance demonstrated that the rate of gastric emptying (slope of the line) was significantly greater in the erythromycin-treated group than in the placebo group (p < 0.0001).


CONCLUSIONS
Early satiety after esophagogastrectomy may be due to delayed gastric emptying and not due to a decrease in the gastric reservoir. Intravenous erythromycin significantly improves gastric emptying in patients after esophagogastrectomy by stimulating gastric motility.
Burt
M
M
Division of Thoracic Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Scott
A
A
Williard
W C
WC
Pommier
R
R
Yeh
S
S
Bains
M S
MS
Turnbull
A D
AD
Fortner
J G
JG
McCormack
P M
PM
Ginsberg
R J
RJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004917:Erythromycin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D005746:Gastric Emptying / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009037:Motilin / Q000819:agonists*; D011446:Prospective Studies; D013268:Stimulation, Chemical; D013671:Technetium Tc 99m Sulfur Colloid
C010948:erythromycin lactobionate; D009037:Motilin; D013671:Technetium Tc 99m Sulfur Colloid; D004917:Erythromycin