Erythromycin enhances early postoperative contractility of the denervated whole stomach as an esophageal substitute

Objective To determine whether early postoperative administration of erythromycin acc elerates the spontaneous motor recovery process after elevation of the dene rvated whole stomach up to the neck. Summary Background Data Spontaneous motor recovery after gastric denervation is a slow process that progressively takes place over years. Methods Erythromycin was administered as follows: continuous intravenous (IV) perfu sion until postoperative day 10 in ten whole stomach (WS) patients ai a dos e of either 1 g (n = 5) or 2 g (n = 5) per day; oral intake at a dose of 1 g/day during 1.5 to 8 months after surgery in 11 WS patients, followed in 7 of them by discontinuation of the drug during 2 to 4 weeks. Gastric motili ty was assessed with intraluminal perfused catheters in these 21 patients, in 23 WS patients not receiving erythromycin, and in ii healthy volunteers. A motility index was established by dividing the sum of the areas under th e curves or >9 mmHg contractions by the lime of recording. Results The motility index after IV or oral administration of erythromycin at and a fter surgery was significantly higher than that without erythromycin (IV, 1 g: p = 0.0090; IV, 2 g: p = 0.0090; oral, 1 g: p = 0.0017). It was similar to that in healthy volunteers (IV, 1 g: p = 0.2818; oral, 1 g: p = 0.7179) and to that in WS patients with >3 years of follow-up who never received e rythromycin UV, 1 g: p = 0.2206; oral, 1 g: p = 0.8326). The motility index after discontinuation of the drug was similar or superior to that recorded under medication in four patients who did not experience any modification of their alimentary comfort, whereas it dropped dramatically parallel to de terioration of the alimentary comfort in three patients. Conclusions Early postoperative contractility of the denervated whole stomach pulled up to the neck under either IV or oral erythromycin is similar to that recove red spontaneously beyond 3 years of follow-up. in some patients, this boost er effect persists after discontinuation of the drug.