Erythromycin decreases the time and improves the quality of EGD in patients with acute upper GI bleeding

AIM: To evaluate the efficacy of erythromycin to decrease the time and improves the quality of EGD in patients with acute upper GI bleeding. BACKGROUND: The diagnostic and therapeutic value of esophagogastroduodenoscopy (EGD) in patients with upper GI bleeding is often limited by the presence of residual blood or clots. Infused erythromycin (3 mg/kg) before EGD, a potent gastro kinetic drug, might improve the quality of EGD in patients with upper GI bleeding and decrease the time of EGD and second- look EGD. PATIENTS AND METHODS: In a prospective, randomized, double-blind controlled trial, 40 patients with acute upper gastrointestinal bleeding in Taleghani hospital, Tehran, Iran were studied. The patients were randomized into 2 groups: 1) nasogastric tube placement receiving placebo, and 2) intravenous erythromycin infusion (3mg/kg at 30 min) combined with nasogastric tube placement. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems and endoscopic duration. Secondary end points were the need for a second look, blood units transfused, and length of hospital stay and mortality. RESULTS: A clear stomach was found more often in the erythromycin group (100% vs. 25%; P < 0.001). Erythromycin shortened the endoscopic duration (14 vs. 32 minutes in the placebo group; P < 0.001) and reduced the need for second-look endoscopy (1 vs. 3; P < 0.001), admission duration (2 vs 5; P < 0.001) and reduced the blood units transfused (2 vs 4; P < 0.001). CONCLUSION: In patients with acute upper GI bleeding, infusion of erythromycin before endoscopy significantly decreases the time and improves the quality of EGD.