A PROSPECTIVE RANDOMIZED TRIAL COMPARING SOMATOSTATIN AND SCLEROTHERAPY IN THE TREATMENT OF ACUTE VARICEAL BLEEDING

Somatostatin and endoscopic sclerotherapy are widely used in the treat ment of acute variceal bleeding. Although objective evidence does exis t about the advantages of either treatment, data comparing both proced ures are scarce. In order to compare the effectiveness and safety of s omatostatin and sclerotherapy in the treatment of acute variceal bleed ing, 70 consecutive cirrhotic patients suffering from esophageal varic eal hemorrhage and meeting the inclusion criteria were randomly assign ed to treatment with somatostatin (35 patients) or sclerotherapy (35 p atients). No differences in age, sex, alcohol intake, etiology of cirr hosis and severity of liver failure were found between groups. Failure of treatment (defined as persistence of bleeding despite therapy or s ubsequent rebleeding within the 48-hr trial period) occurred in seven patients (20%) in the somatostatin group and in six (17.1%) in the scl erotherapy group (NS). Early rebleeding occurred in seven of 28 patien ts (25%) in the somatostatin group and in five of 29 (17.2%) in the sc lerotherapy group (NS). Mortality within the first 6 wk was no differe nt between both groups: 10 (28.5%) and eight (22.8%) in the somatostat in and sclerotherapy groups, respectively. Sclerotherapy, but not soma tostatin, was associated with major complications in five cases (14.2% ) (p = 0.026), two of which resulted in patient's death. These results suggest that somatostatin is safer, and as effective as sclerotherapy , in controlling acute variceal bleeding until an elective treatment c an be established.