title: Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial.
abstract: OBJECTIVE
  The quality of endoscopy depends on the quality of upper gastrointestinal tract preparation. We determine whether in acute upper gastrointestinal bleeding the frequency of satisfactory stomach visualization was different after intravenous erythromycin, a nasogastric tube with gastric lavage, or both.
  
  
  METHODS
  We performed a prospective, randomized, multicenter (6 emergency departments) study in patients with acute upper gastrointestinal bleeding presenting with hematemesis or melena. The patients were randomized into 3 groups: (1) intravenous erythromycin infusion without nasogastric tube placement (erythromycin group), (2) nasogastric tube placement without erythromycin (nasogastric group), and (3) intravenous erythromycin infusion combined with nasogastric tube placement (nasogastric-erythromycin group). The main outcome measure was the proportion of satisfactory stomach visualization.
  
  
  RESULTS
  Two hundred fifty-three patients (181 men, mean age 61 years [SD 15 years], 84 with cirrhosis) were randomized: 84 (erythromycin group), 85 (nasogastric group), and 84 (nasogastric-erythromycin group). Overall, there was 85% satisfactory stomach visualization; between-group differences were not significant: -4% (95% confidence interval [CI] -15% to 6%) for the erythromycin group and nasogastric-erythromycin group, 2% (95% CI -14% to 9%) for the erythromycin group and nasogastric group, and -6.5% (95% CI -17% to 4%) for the nasogastric group and nasogastric-erythromycin group. The duration of the endoscopic procedure, rebleeding frequency, the need for a second endoscopy, the number of transfused blood units, and mortality at days 2, 7, and 30 did not differ significantly between groups.
  
  
  CONCLUSIONS
  In acute upper gastrointestinal bleeding, administration of intravenous erythromycin provides satisfactory endoscopic conditions, without the need for a nasogastric tube and gastric lavage.
authors.affiliation: Emergency Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie-Paris 6 University, Paris, France. dominique.pateron@sat.aphp.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Pateron
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Erwan
authors.initials: E
authors.lastname: Debuc
authors.forename: Karima
authors.initials: K
authors.lastname: Sahraoui
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carbonell
authors.forename: Xavier
authors.initials: X
authors.lastname: Bobbia
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Frédéric
authors.initials: F
authors.lastname: Adnet
authors.forename: Pierre
authors.initials: P
authors.lastname: Nahon
authors.forename: Rolland
authors.initials: R
authors.lastname: Amathieu
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Nicolas
authors.initials: N
authors.lastname: Javaud
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Trinchet
mesh_terms: D004636:Emergency Service, Hospital; D004917:Erythromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005751:Gastric Lavage; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D005773:Gastroscopy / Q000379:methods* / Q000592:standards; D006801:Humans; D007262:Infusions, Intravenous; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged
chemical_list: D005765:Gastrointestinal Agents; D004917:Erythromycin