Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: A randomized clinical trial Journal Article

Authors: Burt, M.; Scott, A.; Williard, W. C.; Pommier, R.; Yeh, S.; Bains, M. S.; Turnbull, A. D.; Fortner, J. G.; McCormack, P. M.; Ginsberg, R. J.
Article Title: Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: A randomized clinical trial
Abstract: Delayed gastric emptying after esophagogastrectomy can pose a significant early postoperative problem. Because erythromycin, which stimulates the gastric antral and duodenal motilin receptor, has been shown to significantly increase gastric emptying in patients with diabetic gastroparesis, we decided to evaluate its effect on gastric emptying after esophagogastrectomy. Methods: Twenty-four patients (18 men and six women, age range 41 to 79 years, median 66 years) were randomized to receive either erythromycin lactobionate (200 mg in 50 ml normal saline solution intravenously) (n = 13) or placebo (50 ml normal saline solution intravenously (n = 11) 11 days after esophagogastrectomy (with pyloric drainage procedure). After erythromycin or placebo had been infused over a 15-minute period, patients ingested a solid meal (scrambled egg with bread) labeled with technetium 99m sulfur colloid (500 ╬╝Ci) over approximately 15 minutes. Dynamic images of the stomach were then acquired over 90 minutes in the supine position by gamma imaging. Results were expressed as percentage of counts retained in the stomach (percent gastric retention) over time. Results: There were no side effects of erythromycin. In the placebo group, the mean percent of radiolabeled meal retained in the stomach after 90 minutes was 88%, which was significantly greater than in the erythromycin group, 37% (p < 0.001). In addition, analysis of covariance demonstrated that the rate of gastric emptying (slope of the line) was significantly greater in the erythromycin-treated group than in the placebo group (p < 0.0001). Conclusion: Early satiety after esophagogastrectomy may be due to delayed gastric emptying and not due to a decrease in the gastric reservoir. Intravenous erythromycin significantly improves gastric emptying in patients after esophagogastrectomy by stimulating gastric motility.
Keywords: adult; clinical article; controlled study; treatment outcome; aged; clinical trial; follow up; controlled clinical trial; randomized controlled trial; diagnostic imaging; postoperative complication; isotope labeling; esophagus resection; gastrectomy; esophagus carcinoma; intravenous drug administration; erythromycin; stomach emptying; stomach paresis; human; male; female; priority journal; article; stomach motility
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 111
Issue: 3
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 1996-03-01
Start Page: 649
End Page: 654
Language: English
DOI: 10.1016/s0022-5223(96)70318-5
PUBMED: 8601981
PROVIDER: scopus
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Samuel D J Yeh
    102 Yeh
  2. Robert J Ginsberg
    178 Ginsberg
  3. Manjit S Bains
    294 Bains
  4. Joseph G Fortner
    36 Fortner
  5. Michael E. Burt
    187 Burt
  6. Andrew M. Scott
    62 Scott