Octreotide for acute esophageal variceal bleeding: a meta-analysis.
OBJECTIVE
Studies of octreotide have not demonstrated a consistent benefit in efficacy or safety compared with conventional therapies. This study statistically pooled existing trials to evaluate the safety and efficacy of octreotide for esophageal variceal hemorrhage.


METHODS
We identified randomized trials of octreotide for variceal hemorrhage from computerized databases, scientific meeting abstracts, and the manufacturer of octreotide. Blinded reviewers abstracted the data, and a meta-analysis was performed.


RESULTS
Octreotide improved control of esophageal variceal hemorrhage compared with all alternative therapies combined (relative risk [RR], 0.63; 95% confidence interval [CI], 0.51-0.77); vasopressin/terlipressin (RR, 0.58; 95% CI, 0.42-0.81); or no additional intervention/placebo (among patients that received initial sclerotherapy/banding before randomization) (RR, 0.46; 95% CI, 0.32-0.67). Octreotide had comparable efficacy to immediate sclerotherapy for control of bleeding (RR, 0.94; 95% CI, 0.55-1.62), fewer major complications than vasopressin/terlipessin (RR, 0.31; 95% CI, 0.11-0.87), and a complication profile comparable to no intervention/placebo (RR, 1.06; 95% CI, 0.72-1.55). No specific alternative therapy demonstrated a mortality benefit.


CONCLUSIONS
These results favor octreotide over vasopressin/terlipressin in the control of esophageal variceal bleeding and suggest it is a safe and effective adjunctive therapy after variceal obliteration techniques. Trials are needed to determine the optimal dose, route, and duration of octreotide treatment.
Division of Gastroenterology, University of California, San Francisco 94143-0538, USA.
D A
DA
Corley
J P
JP
Cello
W
W
Adkisson
W F
WF
Ko
K
K
Kerlikowske
D000208:Acute Disease; D004932:Esophageal and Gastric Varices / Q000150:complications*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D000077585:Terlipressin; D014667:Vasopressins / Q000009:adverse effects / Q000627:therapeutic use
D006490:Hemostatics; D014667:Vasopressins; D008236:Lypressin; D000077585:Terlipressin; D015282:Octreotide