Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double-blind, placebo-controlled trial.

BACKGROUND:

Blood in the stomach and esophagus in patients with variceal bleeding often obscures the endoscopic view and makes endoscopic intervention difficult to perform. Erythromycin, a motilin agonist, induces gastric emptying.

OBJECTIVE:

To assess the effect of erythromycin on endoscopic visibility and its outcome in patients with variceal bleeding.

DESIGN:

Randomized, double-blind, placebo-controlled trial.

SETTING:

Tertiary care hospital.

PATIENTS:

Adult patients with liver cirrhosis presenting with hematemesis within the previous 12 hours.

INTERVENTION:

Either 125 mg erythromycin or placebo administered intravenously 30 minutes before endoscopy.

MAIN OUTCOME MEASUREMENTS:

Endoscopic visibility during index endoscopy and mean duration of procedure.

SECONDARY OUTCOME MEASUREMENTS:

Need for repeat endoscopy and blood transfusions within 24 hours, endoscopy-related complications, and length of hospital stay.

RESULTS:

A total of 102 patients received either erythromycin or placebo (53 erythromycin and 49 placebo). Forty-seven patients in the erythromycin group and 43 in the placebo group had variceal bleeding and were considered for final analysis. A completely empty stomach was seen in 48.9% of the erythromycin group versus 23.3% of the placebo group (P<.01). Mean endoscopy duration was significantly shorter in the erythromycin group than in the placebo group (19.0 minutes vs 26.0 minutes, respectively; P<.005). Length of hospital stay was significantly shorter in the erythromycin group than in the placebo group (3.4 days vs 5.1 days, respectively; P<.002). The need for repeat endoscopy and the mean number of units of blood transfused did not differ significantly in the 2 groups. No adverse events were observed with erythromycin.

LIMITATIONS:

Sample size not sufficient to measure the need for repeat endoscopy and survival benefit.

CONCLUSIONS:

Erythromycin infusion before endoscopy in patients with variceal bleeding significantly improves endoscopic visibility and shortens the duration of the index endoscopy. (

CLINICAL TRIAL REGISTRATION NUMBER:

NCT01060267.).