title: Premedication with erythromycin improves endoscopic visualization of the gastric mucosa in patients with subtotal gastrectomy: a prospective, randomized, controlled trial.
abstract: BACKGROUND
  Food residue in the remnant stomach after subtotal gastrectomy (STG) interferes with endoscopic observation. We investigated whether intravenous erythromycin improves gastric mucosa visualization in patients with STG.
  
  
  METHODS
  This study was conducted from April 2012 to October 2012 as a double-blinded, placebo-controlled, randomized trial. Patients who received STG with complete resection (stage T1-2N0M0) were included. Exclusion criteria were diabetes mellitus, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy influencing gastrointestinal motility and severe comorbidity. Patients were instructed to consume a soft diet for dinner between 1800 and 2000 h, and endoscopies were performed between 0900 and 1200 h. Patients were assigned randomly to receive either erythromycin (125 mg in normal saline 50 cc) or placebo saline. The endoscopy was performed 15 min after infusion. Grade of residual food was rated as follows: G0, no residual food; G1, a small amount of residual food; G2, a moderate amount of residual food; G3, a moderate amount of residual food that hinders observation of the entire surface, even with body rolling; G4, a great amount of residual food such that endoscopic observation is impossible.
  
  
  RESULTS
  When good visibility was defined as G0+G1, visibility was significantly better in the erythromycin group (61 + 19 %) than in the placebo group (38 + 12 %, p < 0.001). However, this effect was not seen in patients within 6 months after gastrectomy. The risk factor for food stasis in the placebo group (n = 58) was food stasis at last endoscopy. The only factor predicting erythromycin response in the erythromycin group (n = 56) was elapsed time since surgery. Adverse effects included nausea [11 (19.7 %)] and vomiting [1 (1.8 %)] in the erythromycin group and vomiting [3 (5.2 %)] in the placebo group. However, they were transient and tolerable.
  
  
  CONCLUSIONS
  Premedication with erythromycin improves mucosal visualization during endoscopy in patients with STG. (
  
  
  BACKGROUND
  NCT01659619).
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, Republic of Korea, ptmaster@gmail.com.
authors.forename: Byoung Yeon
authors.initials: BY
authors.lastname: Jun
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: Jong Yul
authors.initials: JY
authors.lastname: Lee
authors.forename: Myong-Ki
authors.initials: MK
authors.lastname: Baeg
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Moon
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.forename: Jin Su
authors.initials: JS
authors.lastname: Kim
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Kyu Yong
authors.initials: KY
authors.lastname: Choi
mesh_terms: D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004917:Erythromycin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology*; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D005769:Gastrointestinal Motility / Q000187:drug effects; D018589:Gastroparesis; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011292:Premedication / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005765:Gastrointestinal Agents; C010948:erythromycin lactobionate; D004917:Erythromycin