Octreotide in acute bleeding esophageal varices: A prospective randomized study

Background/Aims: To assess the value of octreotide in the central of acute bleeding esophageal varices, in a prospective randomized study. Methodology: One hundred and ninety-seven patients admitted for variceal bl eeding confirmed at endoscopy were recruited and divided into two groups: g roup I (n=111) with endoscopic stigmata of recent bleeding; and group II (n =86) with active bleeding at emergency endoscopy. Patients in group I were randomized to receive a continuous infusion of octreotide (n=58) or emergen cy sclerotherapy (n=53). Patients in group II were assigned to sclerotherap y (n=42) or to sclerotherapy plus octreotide (n=44). At the end of the peri od of study (48 hours), patients were submitted to sclerotherapy or band li gation until variceal obliteration was achieved. Results: In group I, octreotide was found to be as effective as sclerothera py regarding hemostasis at 48 hours and on day 7 after the index bleeding e pisode. Transfusion needs were not significantly different for the two trea tment modalities. Ingroup II, the association of octreotide with sclerother apy was significantly better than sclerotherapy alone either in controlling acute active bleeding (P<0.001) or in achieving hemostasis at 48 hours (P< 0.01). Transfusion needs were significantly fewer in patients treated with this therapeutic association as compared to sclerotherapy alone. Conclusions: These results suggest that octreotide infusion is effective in the treatment of variceal bleeding. In patients with recent bleeding, octr eotide infusion is as effective as emergency sclerotherapy. In active varic eal bleeding, it is a valuable adjuvant treatment in association with : eme rgency sclerotherapy.