PROSPECTIVE RANDOMIZED STUDY OF EFFECT OF OCTREOTIDE ON REBLEEDING FROM ESOPHAGEAL-VARICES AFTER ENDOSCOPIC LIGATION

Up to a third of patients have early rebleeding from oesophageal varic es after endoscopic variceal ligation. Octreotide infusion is effectiv e for control of variceal bleeding. We investigated the efficacy of oc treotide infusion as an adjunct to endoscopic variceal ligation to pre vent early rebleeding from varices. 100 consecutive patients admitted with endoscopically confirmed oesophageal varices and active bleeding or signs of recent haemorrhage were randomly assigned endoscopic varic eal ligation alone or octreotide (50 mu g intravenous bolus injection followed by intravenous infusion at 50 mu g per h for 5 days) plus end oscopic variceal ligation. Three patients in each group were excluded. Bleeding was controlled in 44 of 47 patients who received variceal li gation alone and in 45 of 47 who received combined treatment (p=1 . 0) . Recurrent bleeding was documented in 18 (38% [24-52]) patients who r eceived variceal ligation alone and in four (9% [3-21] who received co mbined treatment (p=0 . 0007). The relative risk of rebleeding was low er (0 . 22 [0 . 08-0 . 60]) in the combined therapy group. Ten patient s in the variceal ligation group and one in the combined therapy group required balloon tamponade for massive haematesis and haemodynamic in stability (p=0 . 0039). The in-hospital and 30-day mortality rates wer e higher in the variceal ligation group than in the combined therapy g roup (19 vs 9% and 23 vs 11%), but the differences did not reach signi ficance. The relative risks of in-hospital (0 . 5 [0 . 04-5 . 3]) and 30-day (0 . 45 [0 . 17-1 . 2]) mortality were lower in the combined th erapy group. Octreotide significantly reduces recurrent bleeding and t he need for balloon tamponade in patients with variceal haemorrhage tr eated by endoscopic variceal ligation.