A prospective randomized trial from turkey comparing octreotide versus injection sclerotherapy in acute variceal bleeding

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.