APPROACH TO THE MANAGEMENT OF BLEEDING ESOPHAGEAL-VARICES - ROLE OF SOMATOSTATIN

Various treatment strategies have been used to control variceal bleedi ng, including drugs, esophageal tamponade, endoscopic sclerotherapy (E S), endoscopic variceal ligation, transjugular intrahepatic portosyste mic shunt and emergency surgery. None of these procedures are ideal an d treatment frequently requires a combination of techniques. Sclerothe rapy is one of the most widely used methods to control variceal bleedi ng; however, success is largely dependent on an experienced endoscopis t. Vasoactive drugs act by decreasing pressure and blood flow in the g astroesophageal collaterals and they offer the advantage of being admi nistered by inexperienced personnel. Drugs currently used in the treat ment of variceal hemorrhage include vasopressin, terlipressin, somatos tatin and octreotide. In the clinical studies to date, somatostatin wa s more effective than vasopressin and as effective as terlipressin in the control of bleeding esophageal varices (BEV), with an improved saf ety profile. In contrast, octreotide has shown conflicting results and more data are required to support the drug in this indication. More r ecently the ABOVE (Acute Bleeding Esophageal Variceal Episodes) study has provided further evidence that early administration of vasoactive drugs such as somatostatin is significantly more effective than placeb o in the overall control of acute BEV episodes in cirrhotic patients u ndergoing ES. Therefore, the administration of a vasoactive drug as ea rly as possible before emergency sclerotherapy is recommended for the effective management of BEV.