Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double-blind, placebo-controlled trial

BackgroundBlood 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.ObjectiveTo assess the effect of erythromycin on endoscopic visibility and its outcome in patients with variceal bleeding.DesignRandomized, double-blind, placebo-controlled trial.SettingTertiary care hospital.PatientsAdult patients with liver cirrhosis presenting with hematemesis within the previous 12 hours.InterventionEither 125 mg erythromycin or placebo administered intravenously 30 minutes before endoscopy.Main Outcome MeasurementsEndoscopic visibility during index endoscopy and mean duration of procedure.Secondary Outcome MeasurementsNeed for repeat endoscopy and blood transfusions within 24 hours, endoscopy-related complications, and length of hospital stay.ResultsA 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 days vs 5.1 days, 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.LimitationsSample size not sufficient to measure the need for repeat endoscopy and survival benefit.ConclusionsErythromycin infusion before endoscopy in patients with variceal bleeding significantly improves endoscopic visibility and shortens the duration of the index endoscopy. (Clinical trial registration number: NCT01060267.)