Erythromycin in UGI bleed

Q: What's the optimum time to administer erythromycin in patients who may require endoscopy in acute upper gastrointestinal (UGI) bleed? 

Answer: Anywhere 30 to 90 minutes prior to endoscopy

Erythromycin is a prokinetic which promotes gastric emptying as it is an agonist of motilin receptors. It improves gastric emptying and so the visualization at endoscopy. Not only it excludes the need of second scope but there is weak evidence that it may even shortens the hospital stay.

It should be given as an intravenous (IV) over 20-30 minutes with the recommended dose of 3 mg/kg.  90 minutes prior to scope is ideal but as acute UGI can be a time-constrained situation, 30 minutes prior to endoscope is also acceptable. 



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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.  Coffin B, Pocard M, Panis Y, et al. Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointest Endosc 2002; 56:174. 

3.  Altraif I, Handoo FA, Aljumah A, et al. Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double-blind, placebo-controlled trial. Gastrointest Endosc 2011; 73:245. 

4.  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. 

5. Rahman R, Nguyen DL, Sohail U, et al. Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review. Ann Gastroenterol 2016; 29:312.