Pre-Endoscopy Erythromycin for Variceal Bleeding

Bleeding from upper gastrointestinal varices into the stomach is often massive and can hamper visualization of the lesion and the ability to perform endoscopic therapy. A possible remedy is the prophylactic use of erythromycin, which has been demonstrated to stimulate gastric emptying in patients with upper gastrointestinal bleeding (JW Gastroenterol Sep 11 2002).

Now, researchers in Saudi Arabia have conducted a randomized, double-blind, placebo-controlled trial involving 102 patients with presumed variceal bleeding to evaluate the effect of pre-endoscopy administration of erythromycin on the presence of blood in the stomach. They also assessed how pre-endoscopy erythromycin affected the duration of the endoscopic procedure, the length of hospitalization, the need for repeat endoscopy, and the number of units of blood transfused. Patients received intravenous erythromycin lactobionate (125 mg) or placebo; both groups received octreotide, omeprazole, antibiotics, and platelet transfusions (if indicated).

Of 90 patients who had variceal bleeding at the time of endoscopy, a higher percentage of erythromycin recipients than placebo recipients had completely empty stomachs (48.9% vs. 23.3%; P<0.01). Erythromycin recipients also experienced relatively shorter mean endoscopy duration (19.0 minutes vs. 26.0 minutes; P<0.005) and shorter mean hospital stay (3.4 days vs. 5.1 days; P<0.002). The number of units of blood transfused and the need for repeat endoscopy were similar between groups. The authors concluded that pre-endoscopy erythromycin infusion improves visualization of lesions and shortens the duration of initial endoscopic procedures.