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

Objective To determine whether early postoperative administration of erythromycin accelerates the spontaneous motor recovery process after elevation of the denervated 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) perfusion until postoperative day 10 in ten whole stomach (WS) patients ai a dose 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 motility 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 the curves or >9 mmHg contractions by the lime of recording. Results The motility index after IV or oral administration of erythromycin at and after 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 erythromycin 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 deterioration 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 recovered spontaneously beyond 3 years of follow-up. in some patients, this booster effect persists after discontinuation of the drug.