[Comparison of terlipressin and octreotide with variceal ligation for controlling acute esophageal variceal bleeding--a randomized prospective study].
OBJECTIVE
Terlipressin and octreotide had been used to control acute variceal bleeding and to prevent early rebleeding after endoscopic hemostasis. We compared the efficacy and safety of terlipressin and octreotide combined with endoscopic variceal ligation (EVL) for the treatment of acute esophageal variceal bleeding and we evaluated their clinical significance as related to rebleeding.


METHODS
The eighty eight cirrhotic patients were randomized to the terlipressin group (n=43; 2 mg i.v. initially and 1 mg i.v. at every 4 hours for 3 days) or the octreotide group (n=45; continuous infusion of 25 microgram/h for 5 days) combined with EVL for the treatment of acute esophageal variceal bleeding.


RESULTS
The initial hemostasis rates were 98% (42/43 cases) in the terlipressin group and 96% (43/45 cases) in the octreotide group. The 5-day and 42-day rebleeding rates were 12% (5/43 cases) and 28% (12/43 cases), respectively, in the terlipressin group and 9% (4/45 cases) and 24% (11/45 cases), respectively, in the octreotide group. No significant difference was demonstrated between the terlipressin and octreotide groups. The mortality at 42 days was similar in both group, but a high mortality rate (48%) was shown to be related to 42-day rebleeding. The risk factors related to 42-day rebleeding were Child-Pugh class C (aOR=30.2, 95% CI=7.7-117.9), ascites above grade II (aOR=6.6, 95% CI=2.2-19.2) and advanced hepatocellular carcinoma (aOR=4.6, 95% CI=1.1-18.9).


CONCLUSIONS
Comparing terlipressin and octreotide combined with EVL showed them to be equally safe and effective therapeutic agents in patients with acute esophageal variceal bleeding. The high risk factors related to early rebleeding were poor liver function and advanced hepatocellular carcinoma.
Cho
Sung Bum
SB
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Park
Kang Jin
KJ
Lee
Jung Soo
JS
Lee
Wan Sik
WS
Park
Chang Hwan
CH
Joo
Young Eun
YE
Kim
Hyun Soo
HS
Choi
Sung Kyu
SK
Rew
Jong Sun
JS
Kim
Sei Jong
SJ
D000208:Acute Disease; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D015282:Octreotide