TERLYPRESSIN AND ENDOSCOPIC SCLEROTHERAPY CONTROL VARICEAL BLEEDING AND PREVENT EARLY REBLEEDING IN CIRRHOTIC-PATIENTS

The efficacy of terlypressin in combination with endoscopic sclerother apy in the emergency control of bleeding from esophageal varices and i n the prevention of early variceal rebleeding in cirrhotic patients wa s assessed in a multicenter randomized trial. In Phase I, emergency tr eatment (days 1 and 2), 596 cirrhotic patients with acute bleeding und erwent sclerotherapy and were simultaneously treated with terlypressin [2 mg intravenously (IV) every 4 hours for 24 hours, followed by 2 mg IV every 6 hours for 24 hours]. Hemostasis was obtained in 96.9% of p atients; 8.3% of patients experienced rebleeding and 5.1% of patients died. In phase II, control of rebleeding, patients with controlled var iceal bleeding were randomly divided into two groups. Subjects in grou p A repeated sclerotherapy on day 7; subjects in group B received scle rotherapy on day 7 together with terlypressin (1 mg IV every 6 hours f rom day 3 to day 7). Both groups were monitored for 21 days and sclero therapy was repeated on days 14, 21, and 28. During phase II of the st udy, rebleeding was observed more frequently in group A than in group B (P = 0.001) and mortality for severe rebleeding was lower in group B , although this finding was not statistically significant. Thus the co mbination of terlypressin with standard endoscopic sclerotherapy durin g the first 7 days after acute variceal bleeding in cirrhotic patients may be more effective than sclerotherapy alone in controlling hemorrh age and in preventing early rebleeding.