SOMATOSTATIN AND OCTREOTIDE IN THE MANAGEMENT OF ACUTE VARICEAL HEMORRHAGE

In recent years, somatostatin and its long-acting analogue octreotide have been used as the initial treatment in acute variceal hemorrhage, with conflicting results. The aim of this study was to meta-analyse al l the randomised controlled trials published in English, in which somo tostatin or octreotide was compared with other vasoactive durgs, ballo on tamponade and endoscopic sclerotherapy in variceal hemorrhage. Conc erning the control of bleeding, somatostatin or octreotide therapy was shown to be significantly better than the other vasoactive drugs (p < 0.0012, x(2) = 10.55). In contrast, the effectiveness of both agents appeared to be similar to that of balloon tamponade and sclerotherapy in arresting acute variceal hemorrhage during the infusion period. Reg arding the complication rate, it appears that treatment with somatosta tin or octreotide is followed by a significantly lower complication ra te as compared with the other vasoactive drugs (p < 0.0001, x(2) = 16. 47) as well, as than endoscopic sclerotherapy (p, 0.0002, x(2) = 14.16 ). In conclusion, the results of this study suggest that in acute vari ceal hemorrhage, somatostatin or octreotide is better than any other; combination of vasoactive drugs. As regards comparison with sclerother apy or balloon tamponade, further evidence of benefit is needed before a recommendation can be made for the use of instead of these two kind of treatments of the former procedures.