Effects of different octreotide dosages on splanchnic hemodynamics and glucagon in patients with TIPS

OBJECTIVE: The aim of this study was to evaluate the hemodynamic effects of octreotide in patients treated with transjugular intrahepatic portosystemi c stent shunt in relation to plasma levels of octreotide and,glucagon and t he correlation between portal pressure and noninvasive Doppler parameters. METHODS: In 15 fasting patients: we i.v. administered isotonic sodium chlor ide followed by octreotide 25 mug/h and 100 mug/h, each over 1 h. We measur ed portal pressure CPP) directly and portal vein blood flow velocity by Dop pler ultrasound simultaneously and calculated port al vascular resistance ( PVR) and portal venous flow (PVF). Blood samples were taken for glucagon an d octreotide (mean +/- SE). RESULTS: Octreotide reduced PP (120 ': -7.7 +/- 2.2%, p < 0.01 vs baseline; 180 ': -11.4 +/- 2.1%, p < 0.01 vs baseline) and PVF(120 ': -21.7 +/- 31.7 %, p < 0.01 vs baseline; 180 ': -11.6 +/- 18.1%, p < 0.05 vs baseline). Glu cagon decreased with the increase in octreotide levels and showed a correla tion with the decrease in PP and with PVF. In patients with a high PVR? we found a close inverse correlation between PP and portal vein blood how velo city (r = -0.83, p = 0.03) as well as CI (r = 0.81, p = 0.05), whereas poor correlation was found in patients with law PVR. CONCLUSIONS: Octreotide caused a dose-related, moderate but sustained reduc tion in PP in patients with transjugular intrahepatic portosystemic stent s hunt. PVR seems to be an important parameter that influences the efficacy o f octreotide and the relation between PP and noninvasive Doppler parameters . (C) 2001 by Am. Cell. of Gastroenterology.