352 Premedication of Erythromycin Improves Endoscopic Mucosal Visualization in Patients With Subtotal Gastrectomy

Abstract

352 Premedication of Erythromycin Improves Endoscopic Mucosal Visualization in Patients With Subtotal Gastrectomy Myung-Gyu Choi*, Byoungyeon Jun, Chul-Hyun Lim, Jae Myung Park, Jin Su Kim, Sang Woo Kim, in Seok Lee, Yu Kyung Cho Dept. of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea Background: food residues in remnant stomach after subtotal gastrectomy interfere endoscopic observation. Incidence of postoperative gastroparesis is reported as 18 42%. The aim of this study was to investigate whether intravenous erythromycin (EM) improves gastric mucosa visualization in patients with subtotal gastrectomy. Methods: This study was a double blinded placebo controlled randomized trial (clinical trial No, NCT01659619). Patients who received subtotal gastrectomy (STG) with complete resection (Stage; T1-2N0M0) were included in this study. Exclusion criteria were as follows; systemic disease with neuromuscular disturbance, DM, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy influencing GI motility and severe comorbidity. Patients were assigned randomly to receive either erythromycin (125 mg in normal saline 50 cc: infusion for 5 min) or placebo (saline). Endoscopy was performed 15 min after infusion. Grade of residual food in remnant stomach was rated as follows; G0 no residual food, G1 a small amount of residual food, G2 a moderate amount of residual food, but possible to observe entire surface of the remnant stomach with body rolling, G3 a moderate amount of residual food which hinders observation of the entire surface even with body rolling, G4 a great amount of residual food for which endoscopic observation is impossible. Results: A total of 116 patients were enrolled with 114 providing outcome data. Patients randomized to EM or placebo had similar demography, elapsed time after surgery, type of surgery and EORTC QLQ-STO22 score. When good visibility was defined as G0 G1, visibility was significantly better in EM group (61% 19%) compared with placebo group (38% 12%, P 0.001). EM enhanced gastric emptying thereby providing good visibility, however this effect was not seen in patients within 6 months after gastrectomy. Risk factors for food stasis in remnant stomach in placebo group were elapsed time after surgery and food stasis at last endoscopy in univariate analysis but food stasis at last endoscopy was the only risk factor in multivariate analysis. Factors predicting EM response in EM group (N 56) were elapsed time after surgery, laparoscopic surgery and type of surgery, but elapsed time after surgery was the only risk factor in multivariate analysis. Adverse Effects included 11 (19.7%) nausea and 1 (1.8%) vomiting in EM group and 3 (5.2%) in placebo group, however, they were transient and tolerable and all patients completed endoscopic examination. Conclusions: premedication of erythromycin improves mucosal visualization during endoscopy in patients with subtotal gastrectomy. Our findings suggest that routine use of erythromycin should be considered before follow-up endoscopy in patients with subtotal gastrectomy.