Clinical trial: The effect of somatostatin vs. octreotide in preventing post-endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices.
BACKGROUND
Hepatic venous pressure gradient (HVPG) increases significantly after endoscopic therapy in patients with bleeding oesophageal varices, which may precipitate further haemorrhage. Whether vasoactive drugs can suppress these changes remains unknown.


OBJECTIVE
To investigate the efficacy of somatostatin when compared with octreotide in preventing the post-endoscopic increase in HVPG during acute bleeding and whether the changes affect outcome.


METHODS
Thirty-three cirrhotics with bleeding varices were randomized to receive somatostatin (n = 17) or octreotide (n = 16) under double-blind conditions, soon after their admission. HVPG measurements were performed before and immediately after endoscopic treatment.


RESULTS
In the somatostatin group, postendotherapy HVPG values did not change significantly when compared with pre-treatment values (18.9 vs. 17.2, P = 0.092). Conversely, in the octreotide group, HVPG increased significantly after endoscopy (18.2 vs. 20.8, P = 0.003). The probability of 6-week survival without treatment failure was significantly higher in the somatostatin group (P = 0.024). Post-endoscopic HVPG value was independently associated with 6-week failure.


CONCLUSIONS
Somatostatin, but not octreotide, effectively prevents the post-endoscopic increase in HVPG, which may be associated with low probability of treatment failure.
Vlachogiannakos
J
J
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece. jvlachog@hotmail.com
Kougioumtzian
A
A
Triantos
C
C
Viazis
N
N
Sgouros
S
S
Manolakopoulos
S
S
Saveriadis
A
A
Markoglou
C
C
Economopoulos
T
T
Karamanolis
D G
DG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy / Q000009:adverse effects; D013004:Somatostatin / Q000009:adverse effects / Q000627:therapeutic use*; D017211:Treatment Failure; D014690:Venous Pressure / Q000187:drug effects*
D013004:Somatostatin; D015282:Octreotide