A randomised controlled trial comparing octreotide vs octreotide plus sclerotherapy in the control of bleeding and early mortality from esophageal varices

Abstract

SUMMARY
Octreotide, the long-acting analogue of somatostatin, has
been used as the initial treatment in acute variceal haemorrhage,
with conflicting results. In this study we compared
octreotide alone with octreotide and sclerotherapy combined
in the control of acute variceal bleeding. The mortality within
a six-week period after the acute variceal haemorrhage
was also examined.
In a prospective trial 30 patients with cirrhosis and variceal
haemorrhage confirmed by endoscopy, were randomized to
two groups (A and B). All patients received octreotide after
admission, in a continuous infusion (50 ìg/h) for five days.
The patients of group A underwent variceal sclerotherapy
with ethanolanime 5% injection at emergency endoscopy.
At 120 hr bleeding was controlled in 100%(15/15) in group
A and 93%(14/15) in group B (NS). Mean transfusion requirements
were not significantly different between the two
groups (group A=2,7 blood units and group B=3,1 blood
units). No side effects were detected in either group and no
deaths observed. The mortality from bleeding recurrence
at six-weeks were: none of group A and 2/15(13%) of group
B (NS).
In conclusion, the results of this study suggest that a five
day course of octreotide alone, without the addition of sclerotherapy
appears to be effective in the emergency control of active variceal bleeding in cirrhosis.
Key words: Octeotide, Sclerotherapy, Esophageal varices,
Bleeding