title: Randomised trial of octreotide for long term management of cirrhosis after variceal haemorrhage.
abstract: OBJECTIVE
  To assess the efficacy of long term octreotide as adjuvant treatment to programmed endoscopic sclerotherapy after acute variceal haemorrhage in cirrhotic portal hypertension.
  
  
  METHODS
  Randomised clinical trial.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  32 patients with cirrhotic portal hypertension.
  
  
  METHODS
  Programmed injection sclerotherapy with subcutaneous octreotide 50 micrograms twice daily for 6 months, or programmed injection sclerotherapy alone.
  
  
  METHODS
  Episodes of recurrent variceal bleeding and survival.
  
  
  RESULTS
  Significantly fewer patients receiving combined octreotide and sclerotherapy had episodes of recurrent variceal bleeding compared with patients given sclerotherapy alone (1/16 v 7/16; P = 0.037, Fisher's exact test), and their survival was significantly improved (P < 0.02, log rank test); this improvement was maintained for 12 months after the end of the study. Combined treatment also resulted in a sustained decrease in portal pressure (median decrease -6.0 mm Hg, interquartile range -10 to -4.75 mm Hg, P = 0.0002) compared with sclerotherapy alone (median increase 1.5 mm Hg, interquartile range 0.25 to 3.25 mm Hg), as well as a significant improvement in liver function as assessed by plasma concentrations of bilirubin, albumin, and alanine aminotransferase and by hepatocyte metabolism of aminopyrine labelled with carbon-14.
  
  
  CONCLUSIONS
  Long term octreotide may be a valuable adjuvant to endoscopic sclerotherapy for acute variceal haemorrhage in cirrhotic portal hypertension.
authors.affiliation: Department of Surgery, Royal Liverpool University Hospital.
authors.forename: S A
authors.initials: SA
authors.lastname: Jenkins
authors.forename: J N
authors.initials: JN
authors.lastname: Baxter
authors.forename: M
authors.initials: M
authors.lastname: Critchley
authors.forename: A N
authors.initials: AN
authors.lastname: Kingsnorth
authors.forename: C A
authors.initials: CA
authors.lastname: Makin
authors.forename: S
authors.initials: S
authors.lastname: Ellenbogen
authors.forename: J S
authors.initials: JS
authors.lastname: Grime
authors.forename: J G
authors.initials: JG
authors.lastname: Love
authors.forename: R
authors.initials: R
authors.lastname: Sutton
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D015911:Sclerotherapy; D015996:Survival Rate; D016896:Treatment Outcome; D014648:Varicose Veins / Q000150:complications*
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide