R. Planas et al., A PROSPECTIVE RANDOMIZED TRIAL COMPARING SOMATOSTATIN AND SCLEROTHERAPY IN THE TREATMENT OF ACUTE VARICEAL BLEEDING, Hepatology, 20(2), 1994, pp. 370-375
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.