The diagnostic and therapeutic value of gastroscopy in patients with upper gastrointestinal (GI) bleeding can often be limited by the presence of residual blood or clots.
In an attempt to overcome this problem, a group of endoscopists from hospitals in Paris, France, have assessed the effect of erythromycin, a potent gastrokinetic drug, on patients with acute upper GI bleeding undergoing such a procedure.
In a randomized, endoscopist-blinded, controlled study, 41 patients admitted to an intensive care unit due to acute upper GI bleeding were either given erythromycin (3 mg/kg intravenously over 3 minutes) or received no additional treatment.
Gastroscopy was performed 30 to 90 minutes after the end of the infusion.
The research group then recorded quality of gastroscopy examination, as assessed on a scale of 0 to 3, and the need to perform a second diagnostic gastroscopy within the next 8 days.
In addition, the efficiency of the endoscopic hemostatic therapy and the intensity of esophagogastroduodenal contractions, as evaluated on a scale of 0-3, were also noted.
3 mg/kg infused 30 minutes prior to the procedure
| Gastrointestinal Endoscopy|
The characteristics of the patients and lesions found following the procedure were similar in both groups.
However, quality of the gastroscopy was significantly better in the erythromycin group (n = 19) compared with the control group (n = 22).
A total of 3 erythromycin-treated patients required a second gastroscopy compared with 10 in the control group.
Erythromycin was found not to interfere with either the performance of the gastroscopy or the efficiency of hemostatic procedures, while the intensity of gastroduodenal contractions was similar in both groups.
No adverse event was observed.
Dr Benoit Coffin, one of the authors of the report, said, "In patients with acute upper GI bleeding, infusion of erythromycin before endoscopy significantly improved the quality of gastroscopy and tended to reduce the need for second-look endoscopy."