Q: 48 year old male with alcoholic cirrhosis is admitted to ICU with upper GI bleed. 2 large bore IVs are inserted. IV PPI and Octreotide drips are started. Blood products are arranged. Gastroenterology service is planning to do upper GI scope. Which one additional treatment may help in better visualization during endoscope?


Answer: intravenous erythromycin

Recommended dose is 3 mg/kg intravenously over half hour, an hour prior to endoscopy. A single dose of intravenous erythromycin given 20 to 120 minutes significantly improve visibility and successful single endoscopy. 


References: 

1. Frossard JL, Spahr L, Queneau PE, et al. Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Gastroenterology 2002; 123:17. 

2. Carbonell N, Pauwels A, Serfaty L, et al. Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Am J Gastroenterol 2006; 101:1211.