Erythromycin accelerates gastric emptying after pancreaticoduodenectomy

A prospective, randomized, placebo-controlled trial

Charles J. Yeo, M. Kevin Barry, Patricia K. Sauter, Samuel Sostre, Keith D. Lillemoe, Henry A. Pitt, John L Cameron

Research output: Contribution to journalArticle

Abstract

Objective This study tested the hypothesis that erythromycin, a motilin agonist, reduces the incidence of early DGE after pancreaticoduodenectomy. Summary Background Data Delayed gastric emptying (DGE) is a leading cause of morbidity after pancreaticoduodenectomy, occurring in up to 40% of patients. The pathogenesis of DGE has been speculated to involve factors such as peritonitis from anastomotic leaks, ischemia to the antropyloric muscles, and gastric atony in response to resection of the duodenal pacemaker or reduction in circulating motilin levels. Methods Between November 1990 and January 1993, 118 patients undergoing pancreaticoduodenectomy completed this prospective, randomized, placebo-controlled trial. The patients received either 200 mg of intravenous erythromycin lactobionate every 6 hours (n = 58), or an identical volume of 0.9% saline (n = 60) from the third to tenth postoperative days. On the tenth postoperative day, a dual phase radionuclide gastric emptying study was performed. Results The erythromycin and control groups were comparable regarding multiple preoperative, intraoperative, and 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 30 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 emptying after pancreaticoduodenectomy and reduces the incidence of DGE by 37%. These data support the use of erythromycin to decrease early DGE after pancreaticoduodenectomy.

Original languageEnglish (US)
Pages (from-to)229-237
Number of pages9
JournalAnnals of Surgery
Volume218
Issue number3
StatePublished - Sep 1993

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Pancreaticoduodenectomy
Gastric Emptying
Erythromycin
Randomized Controlled Trials
Placebos
Motilin
Incidence
Anastomotic Leak
Peritonitis
Radioisotopes
Stomach
Ischemia
Morbidity
Muscles
Control Groups

ASJC Scopus subject areas

  • Surgery

Cite this

Yeo, C. J., Barry, M. K., Sauter, P. K., Sostre, S., Lillemoe, K. D., Pitt, H. A., & Cameron, J. L. (1993). Erythromycin accelerates gastric emptying after pancreaticoduodenectomy: A prospective, randomized, placebo-controlled trial. Annals of Surgery, 218(3), 229-237.

Erythromycin accelerates gastric emptying after pancreaticoduodenectomy : A prospective, randomized, placebo-controlled trial. / Yeo, Charles J.; Barry, M. Kevin; Sauter, Patricia K.; Sostre, Samuel; Lillemoe, Keith D.; Pitt, Henry A.; Cameron, John L.

In: Annals of Surgery, Vol. 218, No. 3, 09.1993, p. 229-237.

Research output: Contribution to journalArticle

Yeo, CJ, Barry, MK, Sauter, PK, Sostre, S, Lillemoe, KD, Pitt, HA & Cameron, JL 1993, 'Erythromycin accelerates gastric emptying after pancreaticoduodenectomy: A prospective, randomized, placebo-controlled trial', Annals of Surgery, vol. 218, no. 3, pp. 229-237.
Yeo CJ, Barry MK, Sauter PK, Sostre S, Lillemoe KD, Pitt HA et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy: A prospective, randomized, placebo-controlled trial. Annals of Surgery. 1993 Sep;218(3):229-237.
Yeo, Charles J. ; Barry, M. Kevin ; Sauter, Patricia K. ; Sostre, Samuel ; Lillemoe, Keith D. ; Pitt, Henry A. ; Cameron, John L. / Erythromycin accelerates gastric emptying after pancreaticoduodenectomy : A prospective, randomized, placebo-controlled trial. In: Annals of Surgery. 1993 ; Vol. 218, No. 3. pp. 229-237.
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abstract = "Objective This study tested the hypothesis that erythromycin, a motilin agonist, reduces the incidence of early DGE after pancreaticoduodenectomy. Summary Background Data Delayed gastric emptying (DGE) is a leading cause of morbidity after pancreaticoduodenectomy, occurring in up to 40{\%} of patients. The pathogenesis of DGE has been speculated to involve factors such as peritonitis from anastomotic leaks, ischemia to the antropyloric muscles, and gastric atony in response to resection of the duodenal pacemaker or reduction in circulating motilin levels. Methods Between November 1990 and January 1993, 118 patients undergoing pancreaticoduodenectomy completed this prospective, randomized, placebo-controlled trial. The patients received either 200 mg of intravenous erythromycin lactobionate every 6 hours (n = 58), or an identical volume of 0.9{\%} saline (n = 60) from the third to tenth postoperative days. On the tenth postoperative day, a dual phase radionuclide gastric emptying study was performed. Results The erythromycin and control groups were comparable regarding multiple preoperative, intraoperative, and 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 30 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 emptying after pancreaticoduodenectomy and reduces the incidence of DGE by 37{\%}. These data support the use of erythromycin to decrease early DGE after pancreaticoduodenectomy.",
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AU - Sauter, Patricia K.

AU - Sostre, Samuel

AU - Lillemoe, Keith D.

AU - Pitt, Henry A.

AU - Cameron, John L

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N2 - Objective This study tested the hypothesis that erythromycin, a motilin agonist, reduces the incidence of early DGE after pancreaticoduodenectomy. Summary Background Data Delayed gastric emptying (DGE) is a leading cause of morbidity after pancreaticoduodenectomy, occurring in up to 40% of patients. The pathogenesis of DGE has been speculated to involve factors such as peritonitis from anastomotic leaks, ischemia to the antropyloric muscles, and gastric atony in response to resection of the duodenal pacemaker or reduction in circulating motilin levels. Methods Between November 1990 and January 1993, 118 patients undergoing pancreaticoduodenectomy completed this prospective, randomized, placebo-controlled trial. The patients received either 200 mg of intravenous erythromycin lactobionate every 6 hours (n = 58), or an identical volume of 0.9% saline (n = 60) from the third to tenth postoperative days. On the tenth postoperative day, a dual phase radionuclide gastric emptying study was performed. Results The erythromycin and control groups were comparable regarding multiple preoperative, intraoperative, and 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 30 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 emptying after pancreaticoduodenectomy and reduces the incidence of DGE by 37%. These data support the use of erythromycin to decrease early DGE after pancreaticoduodenectomy.

AB - Objective This study tested the hypothesis that erythromycin, a motilin agonist, reduces the incidence of early DGE after pancreaticoduodenectomy. Summary Background Data Delayed gastric emptying (DGE) is a leading cause of morbidity after pancreaticoduodenectomy, occurring in up to 40% of patients. The pathogenesis of DGE has been speculated to involve factors such as peritonitis from anastomotic leaks, ischemia to the antropyloric muscles, and gastric atony in response to resection of the duodenal pacemaker or reduction in circulating motilin levels. Methods Between November 1990 and January 1993, 118 patients undergoing pancreaticoduodenectomy completed this prospective, randomized, placebo-controlled trial. The patients received either 200 mg of intravenous erythromycin lactobionate every 6 hours (n = 58), or an identical volume of 0.9% saline (n = 60) from the third to tenth postoperative days. On the tenth postoperative day, a dual phase radionuclide gastric emptying study was performed. Results The erythromycin and control groups were comparable regarding multiple preoperative, intraoperative, and 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 30 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 emptying after pancreaticoduodenectomy and reduces the incidence of DGE by 37%. These data support the use of erythromycin to decrease early DGE after pancreaticoduodenectomy.

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