Erythromycin is not routinely recommended prior to endoscopy for patients with upper gastrointestinal bleeding. While erythromycin may improve endoscopic visibility by reducing blood and clots in the stomach, studies have not shown it consistently improves clinical outcomes. Erythromycin could be considered for patients suspected of having large amounts of fresh blood or clots that could reduce diagnostic yield, but is not warranted for routine use in all patients with upper GI bleeding. Guidelines generally agree promotility agents should not be used routinely before endoscopy, but may be beneficial in selected cases to improve visualization.

1. Erythromycin as a
prokinetic treatment
initiated prior to
endoscopic diagnosis in
upper gastrointestinal
bleeding
Dr. Waleed Kh. S. Mahrous
Gastroenterology and Hepatology Consultant

2. Yes
No
Probably No
Probably Yes
Should we routinely administer
erythromycin before endoscopy in
patients with upper GI bleeding?

3. Visibility during
endoscopic hemostasis

4. Should we routinely administer
erythromycin before endoscopy in
patients with upper GI bleeding?
Yes
No
Probably No
Probably Yes

5. Answer : No , Probably not.
 Among patients who present with UGIB,
only a small percentage are likely to have
a stomach full of blood necessitating
gastric emptying before endoscopy.
 Most guidelines do not recommend the
routine use of erythromycin because there
are no additional clinical benefits aside
from improving endoscopic visibility and
reducing the need for second-look EGDs.

6.  Nevertheless, the use of
erythromycin is recommended for
patients who are suspected of
having poor visibility due to the
presence of large amounts of blood
or clots in their stomachs.

7. However, there was no improvement in other
clinical outcomes, such as duration of
hospitalization, transfusion requirements, or
surgery.
Although the routine use of prokinetic agents is
not recommended, use in patients with a high
probability of having fresh blood or a clot in the
stomach when undergoing endoscopy may result
in a higher diagnostic yield.
American Society for Gastrointestinal Endoscopy 2012

8.  Promotility agents should not be used
routinely before endoscopy to increase the diagnostic
yield.
 (Agree, 82. Grade: Moderate, 2b, “probably don’t
do it”)
 Although the use of preendoscopy promotility agents
may improve diagnostic yield in selected patients with
suspected blood in the stomach, they are not
warranted for routine use in all patients who present
with UGIB.
American College of Physicians 2010

9.  Promotility agents are not promoted
for routine use, but can be used to
improve visualization in patients
suspected to have large amounts of
blood or food residue in the stomach.
2012 by the AGA Institute

10. Pre-endoscopic medical therapy
 Intravenous infusion of erythromycin (250 mg
~30 min before endoscopy) should be
considered to improve diagnostic yield and
decrease the need for repeat endoscopy.
 However, erythromycin has not
consistently been shown to
improve clinical outcomes (Conditional
recommendation).
Am J Gastroenterol 2012

11. Visibility during
endoscopic hemostasis
Based on the results of this study, we hope to develop guidelines on the use of
prokinetics before emergency EGD that will assist in improving visibility during
endoscopic hemostasis procedures.