[Endoscopic versus endoscopic plus octreotide treatment for acute variceal bleeding. Benefit according to severity at admission].
Vasoactive agents plus endoscopic treatment was recommended in esophageal variceal bleeding (EVB). However, the use according to severity on admission has been poorly evaluated


OBJECTIVE
To evaluate the efficacy of endoscopic versus endoscopic plus octreotide treatment in patients with EVB according to severity on admission.


METHODS
Between June 2001 and December 2011, 247 patients with EVB were treated using endoscopic or combined endoscopic plus octreotide treatment. Patients were analyzed according to the following cohorts: all patients, those with and without active bleeding, and by Child classes. Initial hemostatic failure, in-hospital rebleeding and in-hospital mortality were compared with both treatments.


RESULTS
All patients with combined treatment had less initial hemostatic failure (P = 0.0157) and rebleeding (P = 0.0011) when compared to endoscopic treatment. Active bleeding patients and Child C patients had a significant reduction of initial hemostatic failure when receiving combined treatment vs endoscopic treatment (P = 0.0479 and P = 0.0222, respectively). Child C patients and patients without active bleeding significantly decreased rebleeding with combined treatment (P = 0.0139 and P = 0.0056, respectively). Global mortality was 17%, and did not differ between treatments. None patient in Child A died.


CONCLUSIONS
Combined endoscopic plus octreotide treatment in patients with EVB resulted in a reduction of initial hemostatic failure and rebleeding. Moreover, the most relevant effect of combined treatment in decreasing initial hemostatic failure was seen in Child C and active bleeding patients, and for in-hospital rebleeding the same effect was seen in Child C and in patients without active bleeding. Mortality did not differ with both mentioned treatments.
Servicio de Terapia Intensiva, Hospital de Gastroenterología "Dr Carlos Bonorino Udaondo", Buenos Aires, Argentina. julioberreta@googlemail.com
Julio
J
Berreta
Daniel
D
Kociak
Gustavo
G
Romero
Adrián
A
Balducci
Raúl
R
Amaya
Julio
J
Argonz
D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D015282:Octreotide