Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth I pylorus-preserving pancreaticoduodenectomy

Objective To test the hypothesis that early and low doses of erythromycin r educe the incidence of early delayed gastric emptying (DGE) and induce phas e 3 of the migratory motor complex in the stomach after Billroth I pylorus- preserving pancreaticoduodenectomy (PPPD). Summary Background Data Delayed gastric emptying is a leading cause of comp lications after PPPD, occurring in up to 50% of patients. High doses of ery thromycin (200 mg) accelerate gastric emptying after pancreaticoduodenectom y and reduce the incidence of DGE, although they induce strong contractions that do not migrate to the duodenum. Methods Thirty-one patients were randomly assigned to either the erythromyc in or control groups. The patients received erythromycin lactobionate (1 mg /kg) every 8 hours, or H-2-receptor antagonists and gastrokinetic drugs fro m days 1 to 14 after surgery. On postoperative day 30, gastroduodenal motil ity was recorded in 14 patients. Results Preoperative, intraoperative, and postoperative factors were compar able in the erythromycin and control groups. The erythromycin group had a s horter duration of nasogastric drainage, earlier resumption of eating, and a 75% reduction in the incidence of DGE. Erythromycin was an independent in fluence on nasogastric tube removal, and preservation of the right gastric vessels was a significant covariate. Low doses of erythromycin induced phas e 3 of the migratory motor complex and phase 3-like activity, with the same characteristics as spontaneous phase 3, in 86% of patients: two had quiesc ent stomachs and the others had spontaneous phase 3 or phase 3-like activit y. Conclusions Low doses of erythromycin reduced the incidence of DGE by 75% a nd induced phase 3 of the migratory motor complex after Billroth I PPPD. Lo w doses of erythromycin are preferable to high doses in the unfed period af ter PPPD.