IV Erythromycin Before Emergency Endoscopy for Acute Upper GI Bleeding

Successful endoscopic therapy for upper gastrointestinal (UGI) bleeding requires adequate visualization of the bleeding lesions, but visualization can be difficult when bleeding is rapid. Vigorous gastric lavage has long been used to clear blood and clots from the stomach before emergency endoscopy, but this method is variably successful and can produce mucosal injury that may confound the endoscopic evaluation. Use of erythromycin, a motilin agonist that speeds gastric emptying, has been proposed as another method to clear blood from the stomach.

Investigators in Switzerland randomized 105 consecutive patients with acute UGI bleeding who presented with hematemesis to receive either erythromycin (250 mg) or placebo intravenously 20 minutes b…