title: Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.
abstract: OBJECTIVE
  Emergency endoscopy may be difficult in upper gastrointestinal bleeding when blood obscures the visibility. Erythromycin, a motilin agonist, induces gastric emptying. We investigated whether an intravenous bolus infusion of erythromycin would improve the yield of endoscopy in these patients.
  
  
  METHODS
  Patients admitted within 12 hours after hematemesis were randomly assigned to erythromycin (250 mg) or placebo, 20 minutes before endoscopy. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems and endoscopic duration. Secondary end points were the need for a second look, endoscopy-related complications, blood units transfused, and length of hospital stay.
  
  
  RESULTS
  Fifty-one patients received erythromycin and 54 received placebo. A clear stomach was found more often in the erythromycin group (82% vs. 33%; P < 0.001). This difference remained significant in patients with cirrhosis. Erythromycin shortened the endoscopic duration (13.7 vs. 16.4 minutes in the placebo group; P = 0.036) and reduced the need for second-look endoscopy (6 vs. 17 cases; P = 0.018). Length of hospital stay and blood units transfused did not significantly differ between the 2 groups. No complications were noted.
  
  
  CONCLUSIONS
  Erythromycin infusion before endoscopy in patients with recent hematemesis makes endoscopy shorter and easier, thereby reducing the need for a repeat procedure.
authors.affiliation: Division of Gastroenterology and Hepatology, Geneva University Hospitals, Genève, Switzerland. jean-louis.frossard@hcuge.ch
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Frossard
authors.forename: Laurent
authors.initials: L
authors.lastname: Spahr
authors.forename: Pierre Edouard
authors.initials: PE
authors.lastname: Queneau
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Beat
authors.initials: B
authors.lastname: Burckhardt
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Ory
authors.forename: Philippe
authors.initials: P
authors.lastname: De Saussure
authors.forename: Berj
authors.initials: B
authors.lastname: Armenian
authors.forename: Raymond
authors.initials: R
authors.lastname: De Peyer
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D016145:Endoscopy, Digestive System; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D005765:Gastrointestinal Agents; D004917:Erythromycin