RANDOMIZED TRIAL OF OCTREOTIDE FOR LONG-TERM MANAGEMENT OF CIRRHOSIS AFTER VARICEAL HEMORRHAGE

Objective: To assess the efficacy of long term octreotide as adjuvant treatment to programmed endoscopic sclerotherapy after acute variceal haemorrhage in cirrhotic portal hypertension. Design: Randomised clini cal trial. Setting: University hospital. Subjects: 32 patients with ci rrhotic portal hypertension. Interventions: Programmed injection scler otherapy with subcutaneous octreotide 50 mu g twice daily for 6 months , or programmed injection sclerotherapy alone. Main outcome measures: Episodes of recurrent variceal bleeding and survival. Results: Signifi cantly fewer patients receiving combined octreotide and sclerotherapy had episodes of recurrent variceal bleeding compared with patients giv en sclerotherapy alone (1/16 v 7/16; P = 0.037, Fisher's exact test), and their survival was significantly improved (P < 0.02, log rank test ); this improvement was maintained for 12 months after the end of the study. Combined treatment also resulted in a sustained decrease in por tal pressure (median decrease -6.0 mm Hg, interquartile range -10 to - 4.75 mm Hg, P = 0.0002) compared with sclerotherapy alone (median incr ease 1.5 mm Hg, interquartile range 0.25 to 3.25 mm Hg), as well as a significant improvement in liver function as assessed by plasma concen trations of bilirubin, albumin, and alanine aminotransferase and by he patocyte metabolism of aminopyrine labelled with carbon-14. Conclusion : Long term octreotide may be a valuable adjuvant to endoscopic sclero therapy for acute variceal haemorrhage in cirrhotic portal hypertensio n.