Erythromycin as a prokinetic treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding

Dr. Waleed Kh. S. MahrousGastroenterology and Hepatology Consultant

Yes

No

Probably No

Probably Yes

Should we routinely administer erythromycin before

endoscopy in patients with upper GI bleeding?

Visibility during endoscopic hemostas

is

Should we routinely administer erythromycin before

endoscopy in patients with upper GI bleeding?

Yes

No

Probably No

Probably Yes

Answer : No , Probably not.

Among patients who present with UGIB, only a small percentage are likely to have a stomach full of blood necessitating gastric emptying before endoscopy.

Most guidelines do not recommend the routine use of erythromycin

because there are no additional clinical benefits aside from improving endoscopic visibility and reducing the need for second-look EGDs.

Nevertheless, the use of erythromycin is recommended for patients who are suspected of having poor visibility due to the presence of large amounts of blood or clots in their stomachs.

However, there was no improvement in other clinical outcomes, such as duration of hospitalization, transfusion requirements, or surgery.

Although the routine use of prokinetic agents is not recommended, use in patients with a high probability of having fresh blood or a clot in the stomach when undergoing endoscopy may result in a higher diagnostic yield. American Society for Gastrointestinal Endoscopy 2012

Promotility agents should not be used routinely before endoscopy to increase the diagnostic yield.

(Agree, 82. Grade: Moderate, 2b, “probably don’t do it”)

Although the use of preendoscopy promotility agents may improve diagnostic yield in selected patients with suspected blood in the stomach, they are not warranted for routine use in all patients who present with UGIB. American College of Physicians 2010

Promotility agents are not promoted for routine use, but can be used to improve visualization in patients suspected to have large amounts of blood or food residue in the stomach.

2012 by the AGA Institute

Pre-endoscopic medical therapy

Intravenous infusion of erythromycin (250 mg

~30 min before endoscopy) should be considered to improve diagnostic yield and decrease the need for repeat endoscopy.

However, erythromycin has not consistently been shown to improve clinical outcomes (Conditional recommendation).

Am J Gastroenterol 2012

Visibility during endoscopic hemostasis

Based on the results of this study, we hope to develop guidelines on the use of prokinetics before emergency EGD that will assist in improving visibility during endoscopic hemostasis procedures.