D. Benedini, MD A. Pascarella, MD F. Rolfi, MD Division of Gastroenterology S. Orsola FBF Brescia, Italy REFERENCES 1. Westaby D, Williams R. Status of sclerotherapy for variceal bleeding in 1990. Am J Surg 1990;160:32-6. 2. Terblanche J. Has sclerotherapy altered the management of patients with variceal bleeding? Am J Surg 1990;160:27-42. 3. Barsoum MS, Bolous FI, EI-Rooby AA, Rizk-Allah MA, Ibrahim AS. Tamponade and injection sclerotherapy in the management of bleeding oesophageal varices. Br J Surg 1982;69: 76-8. 4. Paquet K-J, Feussner H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial. Hepatology 1985;5:580-3. 5. Larson AW, Cohen H, Zweiban B, et al. Acute esophageal variceal sclerotherapy: results of a prospective randomized controlled trial. JAMA 1986;255:497-500. 6. Soehendra N, Nam V, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy 1986;18:25. 7. Feretis C, Tabakopoulos D, Benakis P, Xenofontos M, Golematis B. Endoscopic hemostasis of esophageal and gastric variceal bleeding with histoacryl. Endoscopy 1990;22:282-4. 8. Gotlib JP. Endoscopic obturation of esophageal and gastric varices with a cyanoacrylic tissue adhesive. Can J Gastroenterol 1990;4:637-8. 9. Stiegmann GV, Goff JS, Sun JH, Davis D, Bozdech J. Endoscopic variceal ligation: an alternative to sclerotherapy. Gastrointest Endosc 1989;35:431-4.

of erythromycin to smooth muscle motilin receptors. 3 ,4 This potent and rapid effect of intravenous erythromycin could be useful in other situations, such as in the preoperative state or before labor when there is a risk of regurgitation and aspiration. 5 Stanislas Chaussade, MD 'Phillipe Sogni, MD Daniel Couturier, MD Jean Guerre, MD Service d'Hepato-gastroenterologie Hopital Cochin Paris, France REFERENCES

1. Janssen J, Peeters TL, Vantrappen G, et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin. N Engl J Med 1990;322:1028-31. 2. Itoh Z, Nakaya M, Suzuki T, Arai H, Wakabayashi K. Erythromycin mimics exogenous motilin in gastrointestinal contractile activity in the dog. Am J Physiol (Gastrointestinal Liver Physiol10) 1984;247:G688-94. 3. Kondo Y, Torii K, Omura S, Itoh Z. Erythromycin and its derivatives with motilin-like biological activities inhibit the specific binding of 1251 motilin to duodenal muscle. Biochem Biophys Res Commun 1988;150:877-82. 4. Peeters TL, Matthijs G, Depoortere I, Cachet T, Hoogmartens J, Vantrappen G. Erythromycin is a motilin agonist. Am J Physiol (Gastrointestinal Liver Physiol 20) 1989;257:G470-4. 5. Scott D. Mendelson's syndrome. Br J Anaesthesia 1978;50: 977-8.

The disappearing colonic irrigation tube Intravenous erythromycin and delayed gastric emptying To the Editor: It has recently been shown that gastric emptying in diabetic patients with severe gastroparesis was accelerated by the use of intravenous doses of erythromycin in smaller doses than used for antibiotic therapy.' This effect was the consequence of the motilin-like effect of erythromycin. 2 We would like to report the acute effect of intravenous erythromycin in eight patients with severe delayed gastric emptying who were referred to an endoscopic unit for gastroscopy. There were two patients with diabetes mellitus, one patient with cirrhosis, and five patients with idiopathic gastroparesis, who had endoscopy for upper gastrointestinal symptoms. Esophagogastroduodenoscopy (Olympus XQ20) showed the presence of retained food in the stomach which prevented a complete examination. An intravenous infusion of erythromycin was carried out immediately (150 mg during a 20-min period) and a second gastroscopy was promptly performed. In each case, the stomach was without a trace of food residue. This study demonstrates that intravenous erythromycin dramatically accelerates gastric emptying in patients with delayed gastric emptying and gastric stasis. This effect can be attributed to the motilin agonist property of erythromycin. 2 Recent in vitro studies have shown that erythromycin is a potent agonist of motilin and that its action on the upper gastrointestinal tract is a direct result of the binding VOLUME 38, NO.6, 1992

To the Editor: Foreign bodies in the gastrointestinal tract usually occur as a result of accidental or intentional ingestion. Most foreign bodies are found in the upper gastrointestinal tract with the esophagus being the most common." 2 Foreign bodies of the lower gastrointestinal tract have also been reported in the literature, with the rectum being the most common. 3- 6 I wish to report a case of a disappearing colon cleansing tube used by a patient with a colostomy for irrigation during hydrotherapy. A 68-year-old man had abdomino-perineal resection with a descending colostomy for adenocarcinoma of the rectum 16 years ago. An upper gastrointestinal series, small bowel series, and a barium enema obtained 6 years ago for intermittent abdominal pain were normal. He became asymptomatic soon thereafter. Recently, he was referred for a surveillance colonoscopy. He had been performing colonic irrigation twice weekly since the surgery. He was advised to stop the irrigation but was reluctant to do so because he believed that the colonic hydrotherapy was an important therapeutic measure to prevent subsequent colon cancer. A colonoscopy performed through the colostomy was unremarkable except for diverticula. Six weeks later, he was seen in the emergency room because his colon irrigation tube had disappeared into the colon during irrigation 18 hours earlier. He had performed the colon irrigation by connecting the irrigation tube (30em length, 24 F) to the matching connector tube and irrigator drain (Hollister'"; Hollister Inc., Libertyville, Ill.) con733

Intravenous erythromycin and delayed gastric emptying.

D. Benedini, MD A. Pascarella, MD F. Rolfi, MD Division of Gastroenterology S. Orsola FBF Brescia, Italy REFERENCES 1. Westaby D, Williams R. Status o...
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