Erythromycin Infusion or Gastric Lavage for Upper Gastrointestinal Bleeding: A Multicenter Randomized Controlled Trial

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• 作者：Dominique Pateron MD^a ; ^{dominique.pateron@sat.aphp.fr"" rel=""nofollow} ; Eric Vicaut MD ; PhD^b ; Erwan Debuc MD^a ; Karima Sahraoui MD^c ; Nicolas Carbonell MD^d ; Xavier Bobbia MD^e ; Dominique Thabut MD^f ; Fré ; dé ; ric Adnet MD ; PhD^g ; Pierre Nahon MD^h ; Rolland Amathieu MDⁱ ; Mounir Aout PhD^b ; Nicolas Javaud MD^j ; Patrick Ray MD^k ; Jean Claude Trinchet MD ; PhD^h ; HDUPE Collaborative Study Group
• 刊名：Annals of Emergency Medicine
• 出版年：2011
• 出版时间：June 2011
• 年：2011
• 卷：57
• 期：6
• 页码：582-589
• 全文大小：741 K

文摘

Study objective

The quality of endoscopy depends on the quality of upper gastrointestinal tract preparation. We determine whether in acute upper gastrointestinal bleeding the frequency of satisfactory stomach visualization was different after intravenous erythromycin, a nasogastric tube with gastric lavage, or both.

Methods

We performed a prospective, randomized, multicenter (6 emergency departments) study in patients with acute upper gastrointestinal bleeding presenting with hematemesis or melena. The patients were randomized into 3 groups: (1) intravenous erythromycin infusion without nasogastric tube placement (erythromycin group), (2) nasogastric tube placement without erythromycin (nasogastric group), and (3) intravenous erythromycin infusion combined with nasogastric tube placement (nasogastric-erythromycin group). The main outcome measure was the proportion of satisfactory stomach visualization.

Results

Two hundred fifty-three patients (181 men, mean age 61 years [SD 15 years], 84 with cirrhosis) were randomized: 84 (erythromycin group), 85 (nasogastric group), and 84 (nasogastric-erythromycin group). Overall, there was 85 % satisfactory stomach visualization; between-group differences were not significant: −4 % (95 % confidence interval [CI] −15 % to 6 % ) for the erythromycin group and nasogastric-erythromycin group, 2 % (95 % CI −14 % to 9 % ) for the erythromycin group and nasogastric group, and −6.5 % (95 % CI −17 % to 4 % ) for the nasogastric group and nasogastric-erythromycin group. The duration of the endoscopic procedure, rebleeding frequency, the need for a second endoscopy, the number of transfused blood units, and mortality at days 2, 7, and 30 did not differ significantly between groups.

Conclusion

In acute upper gastrointestinal bleeding, administration of intravenous erythromycin provides satisfactory endoscopic conditions, without the need for a nasogastric tube and gastric lavage.