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 elythromycin 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 clays vs 5.1 clays, 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: NCT 01060267.) (Gastrointest Enclosc 2011;73:245-50.)