Octreotide in acute bleeding esophageal varices: a prospective randomized study.
OBJECTIVE
To assess the value of octreotide in the control of acute bleeding esophageal varices, in a prospective randomized study.


METHODS
One hundred and ninety-seven patients admitted for variceal bleeding confirmed at endoscopy were recruited and divided into two groups: group 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 emergency sclerotherapy (n = 53). Patients in group II were assigned to sclerotherapy (n = 42) or to sclerotherapy plus octreotide (n = 44). At the end of the period of study (48 hours), patients were submitted to sclerotherapy or band ligation until variceal obliteration was achieved.


RESULTS
In group I, octreotide was found to be as effective as sclerotherapy regarding hemostasis at 48 hours and on day 7 after the index bleeding episode. Transfusion needs were not significantly different for the two treatment modalities. In group II, the association of octreotide with sclerotherapy 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, octreotide infusion is as effective as emergency sclerotherapy. In active variceal bleeding, it is a valuable adjuvant treatment in association with emergency sclerotherapy.
Freitas
D S
DS
Gastroenterology Department, Coimbra University Hospital, Portugal.
Sofia
C
C
Pontes
J M
JM
Gregório
C
C
Cabral
J P
JP
Andrade
P
P
Rosa
A
A
Camacho
E
E
Ferreira
M
M
Portela
F
F
Romãozinho
J M
JM
Tomé
L
L
Gouveia
H
H
Leitão
M
M
Pimenta
I
I
Donato
A
A
D000208:Acute Disease; D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D015911:Sclerotherapy
D015282:Octreotide