title: Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.
abstract: OBJECTIVE
  Presence of clots in the stomach makes emergency endoscopy difficult in patients with upper gastrointestinal bleeding. We investigated whether the association of erythromycin infusion to gastric lavage could improve stomach cleansing before endoscopy.
  
  
  METHODS
  One hundred patients admitted for upper gastrointestinal bleeding were randomly assigned to receive either gastric lavage plus intravenous erythromycin (250 mg) or gastric lavage plus placebo before endoscopy in a double-blind study. The primary end point was the efficacy of intravenous erythromycin to improve stomach cleansing before endoscopy, assessed by both subjective and objective criteria.
  
  
  RESULTS
  Characteristics of patients at admission were similar in both groups. Sixty-six patients had portal hypertension. The gastric mucosa was entirely visualized by the endoscopist in 65% of patients in the erythromycin group, versus 44% in the placebo group (p<0.05). The quality of examination of the upper gastrointestinal tract, assessed by using a 10-cm visual analog scale, was better in the erythromycin group (4.2+/-2 vs. 3.3+/-2.2, p<0.05). Clots were found in the stomach in 30% of patients in the erythromycin group, versus 52% in the placebo group (p<0.05). However, ability to identify the source of bleeding, mean duration of endoscopy, and need for a second-look endoscopy, did not differ between the two groups. Similar results were observed in the subgroup of cirrhotic patients. Erythromycin was well tolerated by all patients.
  
  
  CONCLUSIONS
  Intravenous erythromycin before endoscopy improves stomach cleansing and quality of endoscopic examination in patients with upper gastrointestinal bleeding, but the clinical benefit is limited.
authors.affiliation: Service d'Hépatologie, Hôpital Saint Antoine, Paris, France.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Carbonell
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pauwels
authors.forename: Lawrence
authors.initials: L
authors.lastname: Serfaty
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boelle
authors.forename: Laurent
authors.initials: L
authors.lastname: Becquemont
authors.forename: Raoul
authors.initials: R
authors.lastname: Poupon
mesh_terms: D000208:Acute Disease; D004311:Double-Blind Method; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D005751:Gastric Lavage / Q000379:methods*; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D005773:Gastroscopy; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D004917:Erythromycin