A comparison of two different dosages of somatostatin combined with sclerotherapy for the treatment of acute esophageal variceal bleeding: a prospective randomized trial.
BACKGROUND
the association of somatostatin (SMT) with endoscopic therapy in patients with cirrhosis and variceal bleeding significantly improves the control of the bleeding episode, and hemodynamic data have shown that a dosage of 500 mg/h allows a more marked reduction of portal pressure versus the usual dosage of 250 mg/h.


OBJECTIVE
to assess if the 500 mg/h dosage is associated with an improved outcome.


METHODS
sixty-two patients with variceal bleeding were included in the study. Patients were randomized to receive the usual dosage of SMT (group I: 250 mg/h), or a double dosage (group II: 500 mg/h), together with emergency endoscopic sclerotherapy.


RESULTS
the control of the bleeding episode was similar in both groups of patients. Early rebleeding was less frequent in patients receiving double vs. single dosage of SMT (p = 0.06). When considering patients with advanced liver disease (Child-Pugh B or C) early rebleeding was significantly less frequent in patients receiving the 500 mg/h dose of SMT (39 vs. 13%, p = 0.03).


CONCLUSIONS
the perfusion of higher doses of SMT (500 mg/h) in association with emergency sclerotherapy in patients with cirrhosis and esophageal hemorrhage significantly decreases the rate of early rebleeding in patients with more advanced stages of liver disease.
Palazón
J M
JM
Liver Unit, Hospital General Universitario, Alicante, Spain. palazon_jma@gva.es
Such
J
J
Sánchez-Payá
J
J
Company
L
L
de Madaria
E
E
Sempere
L
L
Martínez
J
J
Zapater
P
P
Pascual
S
S
Carnicer
F
F
Pérez-Mateo
M
M
D000208:Acute Disease; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015911:Sclerotherapy; D013004:Somatostatin / Q000008:administration & dosage*
D013004:Somatostatin