Gastric lavages versus intravenous erythromycin prior to urgent endoscopy for acute upper gastrointestinal bleeding: A randomized trial-preliminary results

Introduction: The diagnostic and therapeutic capacity of the endoscopy in patients with acute upper gastrointestinal bleeding (UGB) is limited by the presence of clots. Different suggesting studies have published that the previous administration of a bolus of intravenous erythromycin improves stomach cleansing before endoscopy. There is not any work that compares the nasogastric tube lavages with the infusion of erythromycin prior to the endoscopy. Aim: determining if the quality of vision of the urgent endoscopy in patients with UGB after administering intravenous erythromycin is comparable to the one obtained with gastric lavages by nasogastric tube. Material and Methods: All patients admitted in emergency room because UGB were randomly assigned to receive gastric lavage or intravenous infusion of erythromycin (250 mg) 30 minutes before the endoscopy. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems (scale of punctuation of Avgerinos modified by Frossard). The subjective scale appraises from 0 to 10 the degree of global visibility of the endoscopy. The objective scale determines 0, 1 or 2 points in each area explored (fundus, corpus, antrum, bulbus and second duodenal portion) depending on the percentage of mucosa covered with blood. As secondary goals requirements described the duration of the endoscopy, the need of a second endoscopy, transfusion requirements and hospital length of stay. Results: 74 patients were randomly assigned to gastric lavage (n=37) and intravenous erythromycin (n=37). Both groups were similar with respect to demographic variables, etiology of the bleeding, form of presentation and hemodynamic state. It did not find differences in the quality of vision of the appraised endoscopy for the subjective scale (erythromycin 8 ± 2.5, nasogastric tube lavage 7.8 ± 2.2, p=0.73) nor for the objective scale (erythromycin 8.89 ± 2.5, nasogastric tube lavage 8.64 ± 1.98, P=0.65). There were not differences with respect to the duration of the endoscopy, the need of a second exploration, transfusion requirements, or length of stay. Conclusion: the intravenous erythromycin is comparable to the nasogastric lavage to improve the visual quality of the urgent endoscopy in patients with UGB.