Erythromycin versus gastric lavage for preendoscopic preparation of patients with upper gastrointestinal bleeding

Abstract

ERYTHROMYCIN VERSUS GASTRIC LAVAGE FOR PREENDOSCOPIC PREPARATION OF PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING RJ Sears. C Duckworth, DH Balaban, KH Han, GF Goldin, DH Oelsner, P Yeaton. Division of Gastroenterology and Hepatology, University of Virgima, Charlottesville, VA. Introduction: Gastric lavage with an Edlich tube is cumbersome to perform, traumatizes the gastrointestinal mucosa, increases patient discomfort, and may be compheated by electrolyte disturbances, aspiration, and perforation. Some investigators challenge its effectiveness, Intravenous erythromycin is well known as a stimulator of gastric emptying. We performed a single-blinded randomized prospective control!ed trial comparing erythromycin versus gastric lavage in clearing the stomach nf obscuring blood in patients with acute upper gastrointestinal bleeding (UGIB). Methods: Patients were enrolled into the study if they had clinical evidence of an active UGIB that was of sufficient severity to warrant gastric lavage prior to endoscopy. Subjects were randomized to receive either erythromycin 250 mg IV one hour prior to endoscopy or gastric lavage via an Edlich tube. Photographs were taken of the fundus, body, and antrum during endoscopy. The endoscopic photographs were examined by a single investigator (PY) who was blinded to the treatment group. The following clot score was assigned to each case regarding the effectiveness of removing obscuring clot: 0-no clot (all mucosa observed); 1minimal clot (exam unimpeded); 2-substantial clot (significant impediment to exam); 3-complete clot (exam futile). Treatment groups were compared using Fisher's exact test and the t-test. Results: 15 patients were recruited (13M, 2F, raean age 63.7 yrs, range 44-75 yrs); 6 received erythromycin, 9 had gastric lavage. There were no differences between the two groups regarding baseline epidemiotogic and laboratory parameters, the amount and type of blood products transfused, type of bleeding lesion (variceal vs nonvariceal), activity of bleeding, or requirement for therapeutics to achieve homeostasis. Mean clot scores for the erythromycin group were significantly lower than the scores for the gastric lavage group (0.67 vs 1.89, p<0.001), A bleeding lesion was identified in every case. Two lavage patients required surgery. No complications or deaths were observed in either group. Erythromycin was welltolerated in all eases. Conclusions: Erythromycin is at least as effective as gastric lavage in clearing blood from the gastric mucosa in patients with UGIB. Eryflu'omycin should be considered an acceptable adjunct to endoscopy for patients with upper gastrointestinal bleeding.