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Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized,
Ibrahim Altraif1, Fayaz A Handoo, Abdulrahman Aljumah
1Department of Clinical Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. Ibrahimtralf@yahoo.com
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 erythromycin 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 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.
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:
NCT01060267.).
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