Korean J Intern Med.  2017 Nov;32(6):1002-1009. 10.3904/kjim.2016.117.

Erythromycin infusion prior to endoscopy for acute nonvariceal upper gastrointestinal bleeding: a pilot randomized controlled trial

• Na HK
• Jung HY
• Seo DW
• Lim H
• Ahn JY
• Lee JH
• Kim DH
• Choi KD
• Song HJ
• Lee GH
• Kim JH

• KMID: 2396759
• DOI: http://doi.org/10.3904/kjim.2016.117

Abstract

BACKGROUND/AIMS
The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy.
METHODS
We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage). The primary outcome was satisfactory visualization. Secondary outcomes included identification of a bleeding source, the success rate of hemostasis, duration of endoscopy, complications related to erythromycin infusion or gastric lavage, number of transfused blood units, rebleeding rate, and bleeding-related mortality.
RESULTS
A total of 43 patients were randomly assigned: 14 patients in the erythromycin group; 15 patients in the gastric lavage group; and 14 patients in the erythromycin + gastric lavage group. Overall satisfactory visualization was achieved in 81% of patients: 92.8% in the erythromycin group; 60.0% in the gastric lavage group; and 92.9% in the erythromycin + gastric lavage group, respectively (p = 0.055). The identification of a bleeding source was possible in all cases. The success rate of hemostasis, duration of endoscopy, and number of transfused blood units did not significantly differ between groups. There were no complications. Rebleeding occurred in three patients (7.0%). Bleeding-related mortality was not reported.
CONCLUSIONS
Intravenous erythromycin infusion prior to emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding seems to provide satisfactory endoscopic visualization.

Keyword

Gastrointestinal hemorrhage; Erythromycin; Gastric lavage; Endoscopy

MeSH Terms

Emergencies
Endoscopy*
Erythromycin*
Gastric Lavage
Gastrointestinal Hemorrhage
Hematemesis
Hemorrhage*
Hemostasis
Humans
Melena
Mortality
Pilot Projects
Prospective Studies
Erythromycin