Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding: A prospective randomized trial

Recent trials have shown that somatostatin (SMT) is as effective as sclerot herapy in the treatment of acute variceal bleeding and that the combination of both treatments is more effective than sclerotherapy alone. To assess w hether the addition of sclerotherapy improves the efficacy of SMT alone, al l patients admitted to our unit with gastrointestinal bleeding and with sus pected cirrhosis received a continuous infusion of SMT (250 mu g/h). Endosc opy was performed between 1 and 5 hours later, and patients with esophageal variceal bleeding were randomized to receive or not to receive sclerothera py. In both groups, SMT infusion was continued for 5 days. Fifty patient ad missions were allocated to each group. Therapeutic failure occurred in 21 c ases of the SMT group and in 7 cases of the combined-therapy group (P =.002 ). Failure to control the acute episode occurred in 24% vs. 8% (P =.03) and early rebleeding in 24% vs. 7% (P =.03), respectively. Transfusional requi rements were significantly higher in the SMT group, while the incidence of complications was lower (8% vs. 24%; P =.029). In the multivariate analysis , the presence of shock at admission and active bleeding during endoscopy w ere the variables that better predicted the failure of therapy with SMT alo ne. Mortality at 6 weeks was similar. These data demonstrate that the addit ion of sclerotherapy significantly improves the efficacy of SMT alone for t he treatment of acute variceal bleeding, although it also increases the rat e of complications. Patients with shock and those with active bleeding are more likely to benefit from this combined therapy.