Prokinetic effect of erythromycin after colorectal surgery: Randomized, placebo-controlled, double-blind study Journal Article

Authors: Smith, A. J.; Nissan, A.; Lanouette, N. M.; Shi, W.; Guillem, J. G.; Wong, W. D.; Thaler, H.; Cohen, A. M.
Article Title: Prokinetic effect of erythromycin after colorectal surgery: Randomized, placebo-controlled, double-blind study
Abstract: PURPOSE: Nausea and vomiting three to seven days after an elective operation on the colon and rectum remain a persistent clinical problem. Erythromycin, a safe, inexpensive drug that stimulates intestinal motilin receptors, has previously been shown to accelerate gastric emptying significantly after upper gastrointestinal surgery. We aimed to evaluate the effect of postoperative intravenous erythromycin on postoperative ileus in patients undergoing elective surgery for primary colorectal cancer. METHODS: Between May 1998 and April 1999, 150 patients undergoing primary resection of colon or rectal cancer were enrolled in this prospective, randomized, placebo-controlled trial. One hundred thirty-four patients completed the study. Patients were excluded if they had extensive metastatic disease, were taking medications known to interact with erythromycin, or if they required an ileostomy. Patients received either 200 mg of intravenous erythromycin or placebo every six hours. Clinical endpoints were recorded and continuous endpoints are presented as mean ± standard deviation. RESULTS: There were no significant complications related to erythromycin. The erythromycin (n = 65) and placebo (n = 69) groups were comparable regarding demographic and operative factors. The erythromycin group had a slightly shorter length of time to passage of flatus (4.1 ± 1.3 vs. 4.4 ± 1.1 days; P = 0.03). There was no significant difference between erythromycin and placebo in time to first solid food (5.6 ± 1.9 vs. 5.4 ± 1.8 days), time to first bowel movement (5.2 ± 1.9 vs. 5.4 ± 1.3 days), or time to discharge from hospital (7.5 ± 2.0 vs. 7.6 ± 2.8 days). There was no difference in the rate of clinically significant nausea (26 vs. 26 percent; P = 0.99), vomiting (17 vs. 16 percent; P = 0.88), or nasogastric tube placement (9 vs. 7 percent; P = 0.68). CONCLUSIONS: Erythromycin does not seem to alter clinically important outcomes related to postoperative ileus in patients undergoing resection for colorectal cancer.
Keywords: adult; controlled study; treatment outcome; aged; middle aged; major clinical study; clinical trial; prospective studies; controlled clinical trial; randomized controlled trial; drug effect; postoperative complication; colorectal neoplasms; ileostomy; colorectal surgery; gastrointestinal surgery; intestinal obstruction; double blind procedure; double-blind method; ileus; infusions, intravenous; randomized trial; erythromycin; elective surgery; nasogastric tube; gastrointestinal agents; prokinetic agent; stimulus response; stomach emptying; postoperative nausea and vomiting; postoperative ileus; humans; human; male; female; article; gastric emptying
Journal Title: Diseases of the Colon and Rectum
Volume: 43
Issue: 3
ISSN: 0012-3706
Publisher: Lippincott Williams & Wilkins  
Date Published: 2000-03-01
Start Page: 333
End Page: 337
Language: English
PUBMED: 10733114
PROVIDER: scopus
DOI: 10.1007/BF02258298
Notes: Export Date: 18 November 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Weiji Shi
    121 Shi
  2. Aviram Nissan
    20 Nissan
  3. Jose Guillem
    404 Guillem
  4. Alfred M Cohen
    242 Cohen
  5. Douglas W Wong
    177 Wong
  6. Howard T Thaler
    240 Thaler
  7. Andrew J Smith
    4 Smith