Volume : 08, Issue : 12, December – 2021
Title:
07.DEVELOPMENT AND CHARACTERIZATION OF LECITHIN-BASED THE EFFECT OF ORAL ERYTHROMYCIN ON THE QUALITY OF ENDOSCOPY IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING
Authors :
Dr Areeba Afzal, Dr Noor u Sabah, Dr Anum Jamil
Abstract :
Background: Bleeding from the upper gastrointestinal tract is a medical emergency. Endoscopy is the preferred therapeutic and diagnostic procedure after the initial stabilization of the patient. However, the presence of blood, blood products, and other residues retained in the stomach is a major challenge for endoscopists during urgent endoscopy following acute upper gastrointestinal bleeding. Intravenous erythromycin before endoscopy improves the visualization of the gastric and duodenal mucosa in these patients. Since oral erythromycin is easier and more convenient to use,
Aim: The aim of our study is to evaluate the effect of oral erythromycin on the quality of endoscopy in patients with upper gastrointestinal bleeding.
Methods: This interventional study was conducted in the Medicine department of Lahore General Hospital for the period of six months from January 2021 to June 2021. Patients with clinical signs of acute upper GI bleeding within 12 hours were considered sequentially. Patients were randomized to an oral erythromycin suspension (500 mg) or a placebo three hours prior to endoscopy. The endoscopist performed all procedures with the same two-channel video endoscope. Endoscopic quality was the primary endpoint. Secondary endpoints included the need for a new endoscopy within 48 hours, endoscopic complications, treatment procedure with or without endoscopy, number of blood transfusions, and length of hospital stay.
Results: A total of 60 patients were enrolled in the study; 30 received erythromycin and 30 received placebo. Of these, 60% were male and 40% female. The mean age was 53.68 ± 16.64 years. The quality of endoscopy was significantly better in the erythromycin group (83.3%) compared to placebo (40%). Erythromycin did not reduce endoscopic time (15.53 vs 14.33 minutes in the placebo group; p = 0.216) and hospital stay (5.23 for erythromycin vs 5.40 days in the placebo group; p = 0.807). There was no statistically significant relationship between the use of erythromycin and the diagnosis of the cause of bleeding, the need for a new endoscopy, the number of blood transfusions and the number of endoscopic procedures.
Conclusion: Oral suspension of erythromycin before endoscopy in patients with acute upper gastrointestinal bleeding resulted in good quality of endoscopy in our study. The visualization of the gastric and duodenal mucosa has been significantly improved. However, this did not shorten the endoscopy or the hospital stay. There was also no significant difference in the number of revision endoscopies and blood transfusions.
Keywords: Erythromycin, Endoscopy, Placebo
Cite This Article:
Please cite this article in press Areeba Afzal et al, Development and Characterization Of Lecithin-Based The effect of Oral Erythromycin On The Quality Of Endoscopy In Patients With Upper Gastrointestinal Bleeding., Indo Am. J. P. Sci, 2021; 08(12).
Number of Downloads : 10
References:
1. Bai Y, Guo JF, Li ZS. Meta‐analysis: erythromycin before endoscopy for acute upper gastrointestinal bleeding. Alimentary pharmacology & therapeutics. 2011 Jul;34(2):166-71.
2. Carbonell N, Pauwels A, Serfaty L, Boelle PY, Becquemont L, Poupon R. Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.
3. Theivanayagam S, Lim RG, Cobell WJ, Gowda JT, Matteson ML, Choudhary A, Bechtold ML. Administration of erythromycin before endoscopy in upper gastrointestinal bleeding: a meta-analysis of randomized controlled trials. Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association. 2013 Sep;19(5):205.
4. Frossard JL, Spahr L, Queneau PE, Giostra E, Burckhardt B, Ory G, De Saussure P, Armenian B, De Peyer R, Hadengue A. Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Gastroenterology. 2002 Jul 1;123(1):17-23.
5. Szary NM, Gupta R, Choudhary A, Matteson ML, Arif M, Hammad HT, Bechtold ML. Erythromycin prior to endoscopy in acute upper gastrointestinal bleeding: a meta-analysis. Scandinavian journal of gastroenterology. 2011 Jul 1;46(7-8):920-4.
6. Pateron D, Vicaut E, Debuc E, Sahraoui K, Carbonell N, Bobbia X, Thabut D, Adnet F, Nahon P, Amathieu R, Aout M. Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial. Annals of emergency medicine. 2011 Jun 1;57(6):582-9.
7. Rahman R, Nguyen DL, Sohail U, Almashhrawi AA, Ashraf I, Puli SR, Bechtold ML. Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology. 2016 Jul;29(3):312.
8. Na HK, Jung HY, Seo DW, Lim H, Ahn JY, Lee JH, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH. Erythromycin infusion prior to endoscopy for acute nonvariceal upper gastrointestinal bleeding: a pilot randomized controlled trial. The Korean journal of internal medicine. 2017 Nov;32(6):1002.
9. Winstead NS, Wilcox CM. Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage: a cost‐effectiveness analysis. Alimentary pharmacology & therapeutics. 2007 Nov;26(10):1371-7.
10. Coffin B, Pocard M, Panis Y, Riche F, Lainé MJ, Bitoun A, Lémann M, Bouhnik Y, Valleur P, Groupe des endoscopistes de garde a l’AP-HP. Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointestinal endoscopy. 2002 Aug 1;56(2):174-9.
11. Rudzki S, Czekalowski S, Michalak K, Kusz W, Fularz A. Erythromycin improves quality of endoscopy for acute upper gastrointestinal bleeding. Wiadomosci Lekarskie (Warsaw, Poland: 1960). 2006 Jan 1;59(7-8):490-1.
12. Daram SR, Garretson R. Erythromycin is preferable to metoclopramide as a prokinetic in acute upper GI bleeding. Gastrointestinal endoscopy. 2011 Jul 1;74(1):234.
13. Habashi SL, Lambiase LR, Kottoor R. Prokinetics Infusion Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding: A Randomized, Controlled, Double-Blind & Placebo-Controlled Trial: 1114. Official journal of the American College of Gastroenterology| ACG. 2007 Sep 1;102:S526.
14. Altraif I, Handoo FA, Aljumah A, Alalwan A, Dafalla M, Saeed AM, Alkhormi A, Albekairy AK, Tamim H. Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double-blind, placebo-controlled trial. Gastrointestinal endoscopy. 2011 Feb 1;73(2):245-50.
15. Leung WK, Chan FK, Fung SS, Wong MY, Sung JJ. Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. World journal of gastroenterology: WJG. 2005 Aug 21;11(31):4865.