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

Abstract

Background/AimsThe 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. MethodsWe 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. ResultsA 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. ConclusionsIntravenous erythromycin infusion prior to emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding seems to provide satisfactory endoscopic visualization.

Oral Erythromycin Improves the Quality of Endoscopy in Upper Gastrointestinal Bleeding Patients

“…Endoscopic related complications, number of blood transfusions and therapeutic procedures during endoscopy did not differ significantly among erythromycin and placebo group. Similar findings were observed by Na et al and Carbonell et al [ 19 , 21 ].…”

“…A meta-analysis published in 2013 including seven randomized control trials showed that the administration of erythromycin before endoscopy in patients with upper GI bleeding significantly improves gastric mucosa visualization (odds ratio, 3.43; p<0.01) when compared with no erythromycin [ 20 ]. Another study conducted in Korea, which randomly assigned patients with upper GI bleeding to the erythromycin group without gastric lavage, gastric lavage only and erythromycin combined with gastric lavage concluded that satisfactory visualization of mucosa was achieved in more than 90% patients of the erythromycin group but only 60% in patients without erythromycin [ 21 ]. Our results are comparable with the above findings; we found that quality of endoscopy was good in 83% patients in the erythromycin group as compared to 40% in the placebo group with a p<.001.…”

Role of endoscopy in acute gastrointestinal bleeding in real clinical practice: An evidence-based review

“…However, it should be remembered that there may be a false negative due to duodenal hemorrhage[35]. One dose of antibiotic erythromycin administered 30 min-120 min before endoscopy is not recommended on a routine basis, but it is recommended to improve endoscopic visualization, reduce the need for transfusion and endoscopy, and reduce the length of hospital stay[42,43]…”

Outcomes of Upper Gastrointestinal Bleeding Based on Time to Endoscopy: A Retrospective Study

“…Out of the patients who underwent an urgent esophagogastroduodenoscopy (EGD), 26.2% needed a second-look EGD 48 hours after the first EGD when compared to 4% and 2% in the early (12-24 hours) and late (>24 hours) endoscopy groups, respectively. In patients who underwent urgent EGD, 23% had active bleeding and it was statistically significant when compared to the other groups.…”

“…Although erythromycin is shown to be beneficial, the studies also differ in the dosage, the ideal timing of the medication before endoscopy, and duration. More studies are needed to understand the clinically useful endpoints [25][26].…”