A team from Geneva, Switzerland, investigated whether an intravenous bolus infusion of erythromycin would improve the yield of endoscopy in patients with acute upper gastrointestinal (GI) bleeding.
Emergency endoscopy may be difficult in upper GI bleeding when blood obscures the visibility. Erythromycin, a motilin agonist, induces gastric emptying.
A total of 105 patients, admitted within 12 hours after hematemesis, were randomly assigned to erythromycin (250 mg, n = 51) or placebo (n = 54), 20 minutes before endoscopy.
Objective and subjective scoring systems and endoscopic duration were used to assess endoscopic yield.
The researchers also noted the need for a second look, endoscopy-related complications, blood units transfused, and length of hospital stay.
A clear stomach was found more often in the erythromycin group (82% vs 33%). This difference also remained significant in patients with cirrhosis.
|Duration of endoscopy:|
Erythromycin: 13.7 min
Placebo: 16.4 min
| Gastroenterology |
It was found that erythromycin shortened the endoscopic duration (13.7 vs 16.4 minutes) and reduced the need for second-look endoscopy (6 vs 17 cases).
However, length of hospital stay and blood units transfused did not significantly differ between the 2 groups.
In addition, no complications were noted.
Dr Jean Louis Frossard, of the Geneva University Hospitals, concluded on behalf of his colleagues, "Erythromycin infusion before endoscopy in patients with recent hematemesis makes endoscopy shorter and easier, thereby reducing the need for a repeat procedure."