A randomized trial of somatostatin (S) versus vasopresin plus nitroglycerin (V/N) in the treatment of acute variceal bleeding (AVB)

Rguez-Moreno, F.; Santolaria, Francisco; Glez-Reimers, E.; Gómez, J. L. Díaz; Banista, N.; Conde, Asunción; Martínez, A.; Rodríguez, E.

doi:10.1016/0168-8278(91)91621-m

Cited by 16 publications

(5 citation statements)

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“…Somatostatin vs. vasopressin has been studied in six RCTs indicating fewer side-effects and a significant improvement in control of bleeding with somatostatin (Table 3). [52][53][54][55][56][57] In addition it has been shown to be as effective as glypressin or sclerotherapy. 47,48 Octreotide is a synthetic analogue of somatostatin with a longer half-life.…”

Section: Somatostatin and Octreotidementioning

confidence: 99%

The management of acute variceal bleeding

Ferguson

Tripathi

Hayes

2003

Aliment Pharmacol Ther

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Summary Variceal haemorrhage is a common medical emergency with a high mortality (30–50%). Adequate resuscitation is vital, and once stabilised the patient should be moved to a high‐dependency area. Antibiotics reduce mortality, and the vasoactive drug terlipressin should be administered if early endoscopy is unavailable. Early endoscopy is essential both to make the diagnosis and to allow therapeutic measures to be performed. The evidence suggests that variceal band ligation is the most effective therapy for oesophageal varices. If gastric varices are found at the index endoscopy the evidence at present is inadequate to be certain which is the best treatment, but both endoscopic therapy with cyanoacrylate or thrombin and transjugular intrahepatic portosystemic stent shunt (TIPSS) have been reported to be of benefit. When initial treatments fail, rescue therapy should be initiated. Most authorities agree that TIPSS is the rescue therapy of choice. Many questions remain concerning the treatment of acute variceal bleeding, particularly the ideal therapy for gastric varices and the role of combination vasoactive and endoscopic therapy. Randomised controlled trials are required to answer these important issues.

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Section: Somatostatin and Octreotidementioning

confidence: 99%

The management of acute variceal bleeding

Ferguson

Tripathi

Hayes

2003

Aliment Pharmacol Ther

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“…Both studies showed that the two drugs were similarly effective in preventing failure to control variceal bleeding and death. It is important to note that, in the largest of these studies [45], a significantly lower incidence of complications in the somatostatin group was reported. These studies suggest that somatostatin must be considered an equivalent drug to terlipressin.…”

Section: Somatostatinmentioning

confidence: 99%

Role of Vasoactive Drugs in the Treatment of Bleeding Oesophageal Varices

Goulis

Burroughs²

1999

Digestion

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“…Three of the trials have compared somatostatin with placebo [37][38][39] and nine have compared somatostatin with vasopressin alone or in combination with nitroglycerin [40][41][42][43][44][45][46] or with terlipressin [47,48]. Two trials have compared somatostatin with BT [49][50][51], four have compared somatostatin with ES alone [52][53][54][55] and one has compared ES with or without somatostatin or octreotide [56].…”

Section: Somatostatinmentioning

confidence: 99%

“…A meta-analysis of available data [17,31,[40][41][42][43][44][45][46], comparing somatostatin with vasopressin alone or in combination with nitroglycerin, showed an important reduction in failure to control bleeding with somatostatin approaching statistical significance, but without any difference in mortality (table 5). In all the trials, complications were virtually absent with somatostatin (median 6.5%; range 0-18%), whereas the median complication rate was 49% (range 17-74%) with vasopressin [17].…”

Section: Somatostatin Vs Vasopressin B Nitroglycerinmentioning

confidence: 99%

Approach to the Management of Bleeding Esophageal Varices: Role of Somatostatin

Avgerinos

1998

Digestion

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Various treatment strategies have been used to control variceal bleeding, including drugs, esophageal tamponade, endoscopic sclerotherapy (ES), endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt and emergency surgery. None of these procedures are ideal and treatment frequently requires a combination of techniques. Sclerotherapy is one of the most widely used methods to control variceal bleeding; however, success is largely dependent on an experienced endoscopist. Vasoactive drugs act by decreasing pressure and blood flow in the gastroesophageal collaterals and they offer the advantage of being administered by inexperienced personnel. Drugs currently used in the treatment of variceal hemorrhage include vasopressin, terlipressin, somatostatin and octreotide. In the clinical studies to date, somatostatin was more effective than vasopressin and as effective as terlipressin in the control of bleeding esophageal varices (BEV), with an improved safety profile. In contrast, octreotide has shown conflicting results and more data are required to support the drug in this indication. More recently the ABOVE (Acute Bleeding Esophageal Variceal Episodes) study has provided further evidence that early administration of vasoactive drugs such as somatostatin is significantly more effective than placebo in the overall control of acute BEV episodes in cirrhotic patients undergoing ES. Therefore, the administration of a vasoactive drug as early as possible before emergency sclerotherapy is recommended for the effective management of BEV.

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A randomized trial of somatostatin (S) versus vasopresin plus nitroglycerin (V/N) in the treatment of acute variceal bleeding (AVB)

Cited by 16 publications

References 0 publications

The management of acute variceal bleeding

The management of acute variceal bleeding

Role of Vasoactive Drugs in the Treatment of Bleeding Oesophageal Varices

Approach to the Management of Bleeding Esophageal Varices: Role of Somatostatin

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