A MULTICENTER RANDOMIZED TRIAL COMPARING OCTREOTIDE AND INJECTION SCLEROTHERAPY IN THE MANAGEMENT AND OUTCOME OF ACUTE VARICEAL HEMORRHAGE

Background-Few studies have compared vasoactive drugs with endoscopic sclerotherapy in the control of acute variceal haemorrhage. Octreotide is widely used for this purpose, but its value remains undetermined. Aims-To compare octreotide with endoscopic sclerotherapy for acute var iceal haemorrhage. Patients-Consecutive patients with acute variceal h aemorrhage. Methods-Patients were randomised at endoscopy to receive e ither a 48 hour intravenous infusion of 50 mu g/h octreotide (n=73), o r emergency sclerotherapy (n=77). Results-Overall control of bleeding and mortality was not significantly different between octreotide (85%, 62 patients) and sclerotherapy (82%, 63 patients) over the 48 hour tr ial period (relative risk of rebleeding 0.83; 95% confidence interval (CI) 0.38 to 1.82), irrespective of Child's grading or active bleeding at endoscopy. One major complication was observed in the sclerotherap y group (aspiration) and two in the octreotide group (pulmonary oedema , severe paralytic ileus). During 60 days of follow up there was an ov erall trend towards an increased mortality in the octreotide group whi ch was not statistically significant (relative risk of dying at 60 day s 1.91, 95% CI 0.97 to 3.78, p=0.06). Conclusions-The results of this study indicate that intravenous octreotide is as effective as injectio n sclerotherapy in the control of acute variceal bleeding, but further controlled trials are necessary to evaluate the safety of this treatm ent.