Early Administration of Vapreotide for Variceal Bleeding in Patients with Cirrhosis

Abstract

In patients with cirrhosis and variceal bleeding, the combination of vapreotide and endoscopic treatment is more effective than endoscopic treatment alone as a method of controlling acute bleeding. However, the use of combination therapy does not affect mortality rates at 42 days.

Use of portal pressure studies in the management of variceal haemorrhage

“…Prolonged hypovolaemia increases the risk of complications such as infection and renal failure which are associated with higher mortality and rebleeding rates [18,19] . Early administration of vasoactive drugs facilitates endoscopy, improves control of bleeding and reduces 5 d rebleeding rates [20][21][22] . In addition, drug therapy will improve the outcome even if commenced after endoscopic sclerotherapy or band ligation [23,24] .…”

Drug therapies in liver disease

“…34 Early administration of vapreotide has been shown in one French study to reduce the need for blood transfusion and to improve control of variceal bleeding. 35 Meta-analysis has demonstrated that terlipressin (a longacting analogue of vasopressin) leads to a 34% relative risk reduction in mortality compared with placebo. However, it has not been demonstrated that terlipressin is superior to octreotide, somatostatin or endoscopic treatment alone.…”

Management of Acute Variceal Bleeding

“…Lanreotide was tested mainly in animal models. Vapreotide was better in comparison with placebo and was proved to increase the efficacy of endoscopic treatment in variceal bleeding in humans [42]. None of these other analogues are currently used in common clinical practice.…”