Surgical Endoscopy

, Volume 28, Issue 5, pp 1641–1647 | Cite as

Premedication with erythromycin improves endoscopic visualization of the gastric mucosa in patients with subtotal gastrectomy: a prospective, randomized, controlled trial

  • Byoung Yeon Jun
  • Myung-Gyu Choi
  • Jong Yul Lee
  • Myong-Ki Baeg
  • Sung Jin Moon
  • Chul-Hyun Lim
  • Jin Su Kim
  • Yu Kyung Cho
  • In Seok Lee
  • Sang Woo Kim
  • Kyu Yong Choi
Article
First Online:
Received:
Accepted:

Abstract

Background

Food residue in the remnant stomach after subtotal gastrectomy (STG) interferes with endoscopic observation. We investigated whether intravenous erythromycin improves gastric mucosa visualization in patients with STG.

Methods

This study was conducted from April 2012 to October 2012 as a double-blinded, placebo-controlled, randomized trial. Patients who received STG with complete resection (stage T1–2N0M0) were included. Exclusion criteria were diabetes mellitus, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy influencing gastrointestinal motility and severe comorbidity. Patients were instructed to consume a soft diet for dinner between 1800 and 2000 h, and endoscopies were performed between 0900 and 1200 h. Patients were assigned randomly to receive either erythromycin (125 mg in normal saline 50 cc) or placebo saline. The endoscopy was performed 15 min after infusion. Grade of residual food was rated as follows: G0, no residual food; G1, a small amount of residual food; G2, a moderate amount of residual food; G3, a moderate amount of residual food that hinders observation of the entire surface, even with body rolling; G4, a great amount of residual food such that endoscopic observation is impossible.

Results

When good visibility was defined as G0+G1, visibility was significantly better in the erythromycin group (61 + 19 %) than in the placebo group (38 + 12 %, p < 0.001). However, this effect was not seen in patients within 6 months after gastrectomy. The risk factor for food stasis in the placebo group (n = 58) was food stasis at last endoscopy. The only factor predicting erythromycin response in the erythromycin group (n = 56) was elapsed time since surgery. Adverse effects included nausea [11 (19.7 %)] and vomiting [1 (1.8 %)] in the erythromycin group and vomiting [3 (5.2 %)] in the placebo group. However, they were transient and tolerable.

Conclusions

Premedication with erythromycin improves mucosal visualization during endoscopy in patients with STG. (Clinical Trials registration number: NCT01659619).

Keywords

Erythromycin Gastroparesis Gastrectomy Endoscopy 
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Notes

Acknowledgments

This study was supported by Business of Globalization for Science and Technology funded by the Ministry of Education, Science and Technology, Seoul, Republic of Korea (Grant NRF-2011-0031644).

Disclosures

Byoung Yeon Jun, Myung-Gyu Choi, Jong Yul Lee, Myong-Ki Baeg, Sung Jin Moon, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho, In Seok Lee, Sang Woo Kim, and Kyu Yong Choi have no conflict of interest or financial ties to disclose

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Byoung Yeon Jun
    • 1
  • Myung-Gyu Choi
    • 1
  • Jong Yul Lee
    • 1
  • Myong-Ki Baeg
    • 1
  • Sung Jin Moon
    • 1
  • Chul-Hyun Lim
    • 1
  • Jin Su Kim
    • 1
  • Yu Kyung Cho
    • 1
  • In Seok Lee
    • 1
  • Sang Woo Kim
    • 1
  • Kyu Yong Choi
    • 1
  1. 1.Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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