ERYTHROMYCIN ACCELERATES GASTRIC-EMPTYING AFTER PANCREATICODUODENECTOMY - A PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

Objective This study tested the hypothesis that erythromycin, a motili n agonist, reduces the incidence of early DGE after pancreaticoduodene ctomy. Summary Background Data Delayed gastric emptying (DGE) is a lea ding cause of morbidity after pancreaticoduodenectomy, occurring in up to 40% of patients. The pathogenesis of DGE has been speculated to in volve factors such as peritonitis from anastomotic leaks, ischemia to the antropyloric muscles, and gastric atony in response to resection o f the duodenal pacemaker or reduction in circulating motilin levels, M ethods Between November 1990 and January 1993, 118 patients undergoing pancreaticoduodenectomy completed this prospective, randomized, place bo-controlled trial. The patients received either 200 mg of intravenou s erythromycin lactobionate every 6 hours (n = 58), or an identical vo lume of 0.9% saline (n = 60) from the third to tenth postoperative day s. On the tenth postoperative day, a dual phase radionuclide gastric e mptying study was performed. Results The erythromycin and control grou ps were comparable regarding multiple preoperative, intraoperative, an d postoperative factors. The erythromycin group had a 37% reduction in the incidence of DGE (19% vs. 30%), a significantly reduced (p < 0.05 ) need to reinsert a nasogastric tube for DGE (6 vs. 15 patients), and a significantly reduced (p < 0.01) per cent retention of liquids at 3 0 minutes and solids at 30, 60, 90, and 120 minutes. No major adverse reactions to erythromycin were observed. Conclusions Erythromycin is a safe, inexpensive drug that significantly accelerates gastric emptyin g after pancreaticoduodenectomy and reduces the incidence of DGE by 37 %. These data support the use of erythromycin to decrease early DGE af ter pancreaticoduodenectomy.