Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.
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.
Frossard
Jean Louis
JL
Division of Gastroenterology and Hepatology, Geneva University Hospitals, Genève, Switzerland. jean-louis.frossard@hcuge.ch
Spahr
Laurent
L
Queneau
Pierre Edouard
PE
Giostra
Emiliano
E
Burckhardt
Beat
B
Ory
Gaëlle
G
De Saussure
Philippe
P
Armenian
Berj
B
De Peyer
Raymond
R
Hadengue
Antoine
A
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
D005765:Gastrointestinal Agents; D004917:Erythromycin