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Enhancement of Gastric Emptying of Solids by Erythromycin in Patients With Roux-en-Y Gastrojejunostomy
John Petrakis, MD, PhD;
John Sophocles Vassilakis, MD, PhD;
Nikolaos Karkavitsas, MD, PhD;
George Tzovaras, MD, PhD;
Emmanuel Epanomeritakis, MD;
John Tsiaoussis, MD, PhD;
Evaghelos Xynos, MD, PhD
Arch Surg. 1998;133:709-714.
Background Roux-en-Y reconstruction is sometimes associated with symptoms that suggest food stasis, as a result of dysmotility of either the gastric remnant and/or the efferent jejunal limb.
Objective To study the possible effect of intravenous erythromycin lactobionate on gastric emptying of solids in patients who have undergone a Roux-en-Y procedure.
Patients Twenty-four patients with a Roux-en-Y procedure participated in the study. Ten of them had undergone truncal vagotomy with pyloroplasty; the remaining 14 had undergone a Billroth II subtotal gastrectomy as the initial antiulcer procedure. Sixteen healthy subjects served as controls.
Methods All healthy subjects and patients underwent assessment of gastric emptying of a standard radiolabeled solid meal after administration of placebo or 200 mg of erythromycin lactobionate intravenously. Scanning was done with a gamma camera, and emptying curves were constructed. From these curves the half-time of gastric emptying was calculated.
Results Patients with severe symptoms of gastric stasis had a significantly longer half-time than did patients with mild or no symptoms (P=.002). Patients with a Billroth II subtotal gastrectomy as the initial antiulcer procedure had a significantly worse grade of symptoms (P=.01) and a significantly prolonged half-time (P=.02) compared with patients with a truncal vagotomy with pyloroplasty as the initial antiulcer procedure. Erythromycin significantly reduced the half-time in the controls (P<.001) and all patients after Roux-en-Y procedure (P<.001).
Conclusion Erythromycin could be a useful prokinetic drug in patients with Roux stasis syndrome.
From the Departments of General Surgery (Drs Petrakis, Vassilakis, Tzovaras, Epanomeritakis, Tsiaoussis, and Xynos) and Nuclear Medicine (Dr Karkavitsas), University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece.
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