Manometric evidence of improved early gastric stasis by erythromycin afterpylorus-preserving pancreatoduodenectomy

Gastric stasis is a frequent complication of pylorus-preserving pancreatodu odenectomy (PPPD). We demonstrated that it might be attributable to delayed recovery of phase III activity of the gastric migrating motor complex due to low concentrations of plasma motilin caused by resection of the duodenum . Leucine 13-motilin is effective for treating gastric stasis, but it is no t yet available for clinical use. Whether erythromycin would improve early gastric stasis after PPPD was tested clinically and by manometry. A manomet ric tube assembly and a gastrostomy tube were inserted in the stomach of 10 patients at PPPD for pressure recording from the gastric antrum and jejunu m and for gastric juice drainage, respectively. After baseline recording, e rythromycin 5 mg/kg was given intravenously on day 14 and saline as a place bo on day 17 every I hours four times a day. The daily volume of gastric ju ice output and the gastric motility index were measured. The mean period un til the return of gastric phase III was 31 +/- 1 days. Erythromycin signifi cantly increased the gastric motility index from 7.9 +/- 1.3 mmHg to 15.7 /- 1.8 mmHg (p = 0.0005), whereas saline did not (7.2 +/- 1.6 mmHg to 6.5 /- 1.2 mmHg; p = 0.21). Erythromycin significantly decreased the gastric ju ice output from 1080 +/- 190 mi to 738 +/- 199 ml (p < 0.0001), but the sal ine injections did not (1064 +/- 174 mi to 1115 +/- 189 mi; p = 0.35). Eryt hromycin, a universally available motilin agonist, is a safe, effective, po tent drug for the treatment of early gastric stasis after PPPD.