Emergency endoscopic variceal ligation versus somatostatin for acute esophageal variceal bleeding.
BACKGROUND
Endoscopic variceal ligation and somatostatin are widely used for treating acute esophageal variceal bleeding. This study compared the efficacy, safety, and survival of both therapies.


METHODS
Acute esophageal variceal bleeding patients were randomized to undergo emergency ligation or receive a bolus of 250 microg somatostatin plus infusion at 250 microg/hour for 48 hours and undergo ligation subsequently.


RESULTS
Three (4.8%) of 62 patients in the ligation group and 20 (31.7%) of 63 patients in the somatostatin group encountered treatment failure (p = 0.0001). Transfusion requirements were 4.7 +/- 3.2 units in the ligation group and 6.9 +/- 7.3 units in the somatostatin group (p = 0.03). Hospital stay was 7.7 +/- 4.0 days in the ligation group and 10.2 +/- 9.9 days in the somatostatin group (p = 0.07). Adverse effects occurred in the ligation group (20 episodes) and the somatostatin group (27 episodes) (p = 0.2). The 42-day mortality rates were 5 patients (8.1%) in the ligation group and 3 patients (4.8%) in the somatostatin group (p = 0.5).


CONCLUSIONS
Emergency ligation was superior to somatostatin in treating acute esophageal variceal bleeding, with fewer requirements of transfusion and a tendency toward shorter hospital stay. The adverse effects and 42-day mortality rates were similar between both treatments.
Chen
Wen-Chi
WC
Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC.
Lo
Gin-Ho
GH
Tsai
Wei-Lun
WL
Hsu
Ping-I
PI
Lin
Chiun-Ku
CK
Lai
Kwok-Hung
KH
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013004:Somatostatin / Q000627:therapeutic use*; D017211:Treatment Failure
D013004:Somatostatin