B. Sivri et al., A prospective randomized trial from turkey comparing octreotide versus injection sclerotherapy in acute variceal bleeding, HEP-GASTRO, 47(31), 2000, pp. 168-173
BACKGROUNDS/AIMS: Bleeding from gastroesophageal varices continues to be a
life threatening complication of chronic liver diseases and portal hyperten
sion. The purpose of this randomized prospective study is to compare the ef
ficacy of octreotide administration and emergency injection sclerotherapy f
or the control of actively bleeding esophageal varices and prevention of ea
rly rebleeding in patients with cirrhosis.
METHODOLOGY: A total of 66 episodes of endoscopically proven active varicea
l bleeding in 52 patients were included in this study. Following admission
to the hospital, the patients were resuscitated with blood and plasma, and
fiberoptic endoscopy was performed within 2 hours. Thirty-six bleeds in 28
patients and 30 bleeds in 24 patients were randomized to endoscopic varicea
l sclerotherapy (1% polidocanol) and to octreotide infusion (at 50 mu g/h f
or 12 hours following the initial 50 mu g i.v, bolus), respectively.
RESULTS: Bleeding was initially controlled within 6 hours in 75% of episode
s by endoscopic variceal sclerotherapy and in 73.3 by octreotide infusion (
P>0.05). There were no significant differences between the 2 groups in earl
y rebleeding (within 72 hours of randomization) (22% vs. 22.7%), blood tran
sfusion (4.2+/-1.8 units vs. 4.8+/-2.9 units), or hospital mortality (3.6%
vs. 3.3%). Treatment failed in 9 episodes (25%) in the sclerotherapy group
and in 8 episodes (26.7%) in the octreotide group.
CONCLUSIONS: We consider that Octreotide would appear to be as effective as
sclerotherapy in both the early control of variceal hemorrhage and in the
prevention of early recurrent bleeding and should therefore be considered t
he treatment of choice in those centers where 24-hour endoscopy is not avai
lable. Furthermore, even in hospitals that do have a 24-hour endoscopy serv
ice there is good evidence that octreotide therapy should be commenced as s
oon as a patient enters hospital with a suspected variceal bleed to achieve
rapid homeostasis. When initial hemostasis is achieved, elective endoscopi
c therapies can be undertaken with greater success.