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 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 P P 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.)