SANDOSTATIN THERAPY OF ACUTE ESOPHAGEAL VARICEAL BLEEDING

This communication deals with the emergency control of variceal bleedi ng rather than the prevention of rebleeding. The current main options of oesophageal tamponade, emergency sclerotherapy and drug therapy are discussed, with particular reference to the use of somatostatin. Sand ostatin (Sandoz, Basel), a synthetic long-acting somatostatin analogue , was found to reduce transhepatic venous gradient by 30% with no effe ct on systemic haemodynamics in a study of 16 stable cirrhotic patient s. In a trial comparing intravenous infusion of Sandostatin (SMS) to o esophageal tamponade (OT) in active variceal bleeding, 18 of 20 bleeds in the SMS group and 19 of 20 bleeds in the OT group were controlled at 4 h. Ten in the SMS group and 14 in the OT group had no further ble eding during the 48-hour study period. Thus SMS may be useful in the t emporary control of active variceal bleeding.