The presence of clots in the stomach makes emergency endoscopy difficult in patients with upper gastrointestinal bleeding.
Dr Nicholas Carbonell and colleagues from France investigated whether the association of erythromycin infusion to gastric lavage could improve stomach cleansing before endoscopy.
The team included 100 patients with upper gastrointestinal bleeding.
The patients received either gastric lavage plus intravenous erythromycin 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.
|Clots were found in the stomach in 30% of the erythromycin group|
|American Journal of Gastroenterology|
The researchers found that the characteristics of patients at admission were similar in both groups.
The team noted that 66 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.
The quality of examination of the upper gastrointestinal tract, assessed by using a 10-cm visual analog scale, was better in the erythromycin group.
The research team found clots in the stomach in 30% of patients in the erythromycin group, versus 52% in the placebo group.
However, the ability to identify the source of bleeding, mean duration of endoscopy, and need for a second-look endoscopy, did not differ between the 2 groups.
The team observed similar results in the subgroup of cirrhotic patients.
In addition, the researchers noted that erythromycin was well tolerated by all patients.
Dr Carbonell's team concluded, “Intravenous erythromycin before endoscopy improves stomach cleansing and quality of endoscopic examination in patients with upper gastrointestinal bleeding, but the clinical benefit is limited.”