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.