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The use of metoclopramide in acute pyloric obstruction. A clinical trial.

Twelve patients with complete, or nearly complete, pyloric obstruction due to duodenal ulcer, were treated conservatively with metoclopramide. The purpose of this therapeutic trial was to avoid emergency operations in these patients and to enable a better radiological evaluation and clinical preparation before surgery. The treatment, in addition to the usual gastric decompression and fluid and electrolyte replacement therapy, was effective in 10 patients (83.4 percent). In eight of these patients the results of the trial was regarded as "very good". Six of them were operated upon electively later and two were not operated upon at all. In two patients the results were regarded as "good". These patients underwent early elective surgery. In the remaining two patients (16.6 percent) the trial failed and semiurgent operation could not be avoided. As no side-effects are evident following the administration of metoclopramide and no harm is done by delaying surgery for three days, it is suggested that this therapeutic trial should be undertaken in every case of pyloric stenosis or obstruction. This may markedly reduce the need for emergency operation and prevent many postoperative complications which not uncommonly follow emergency surgery for pyloric stenosis.