Effects of bolus injections and continuous infusions of somatostatin and placebo in patients with cirrhosis: A double-blind hemodynamic investigation

Cirera, Isabel; Feu, Faust; Luca, Angelo; García-Pagán, J.C.; Fernández, Mercedes; Escorsell, Àngels; Bosch, Jaime; Rodés, Joan

doi:10.1002/hep.1840220117

Cited by 79 publications

(92 citation statements)

References 31 publications

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“…6 In this study, we found that SST but not OCT effectively prevented the increase in WHVP with simultaneous increase in FHVP achieving an almost unchanged portal pressure. This is consistent with the findings of Cirera et al, 31 where the recorded reduction in the HVPG after the administration of SST was attributed to a significant decline in WHVP accompanied by a marked increase in FHVP. Although both SST and OCT inhibit the secretion of glucagon through binding with SST receptors 2, their different effects on splanchnic haemodynamics suggest involvement of other mechanisms.…”

Section: Discussionsupporting

confidence: 93%

Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices

Vlachogiannakos

Kougioumtzian

Triantos

et al. 2007

Aliment Pharmacol Ther

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Section: Discussionsupporting

confidence: 93%

Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices

Vlachogiannakos

Kougioumtzian

Triantos

et al. 2007

Aliment Pharmacol Ther

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“…[6][7][8]10,12,13 It has been demonstrated that bolus injections of SMT cause a rapid and more pronounced reduction of portal pressure and azygos blood flow than those observed with continuous infusion. 26 These marked hemodynamic effects may explain, at least in part, the higher efficacy reported in clinical trials using additional boluses. However, the present study clearly shows that the combination of Abbreviation: PSTV, transient paroxysmal supraventricular tachycardia.…”

Section: Discussionmentioning

confidence: 99%

Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding: A prospective randomized trial

et al. 1999

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Recent trials have shown that somatostatin (SMT) is as effective as sclerotherapy in the treatment of acute variceal bleeding and that the combination of both treatments is more effective than sclerotherapy alone. To assess whether the addition of sclerotherapy improves the efficacy of SMT alone, all patients admitted to our unit with gastrointestinal bleeding and with suspected cirrhosis received a continuous infusion of SMT (250 g/h). Endoscopy was performed between 1 and 5 hours later, and patients with esophageal variceal bleeding were randomized to receive or not to receive sclerotherapy. In both groups, SMT infusion was continued for 5 days. Fifty patient admissions were allocated to each group. Therapeutic failure occurred in 21 cases of the SMT group and in 7 cases of the combinedtherapy group (P ‫؍‬ .002). Failure to control the acute episode occurred in 24% vs. 8% (P ‫؍‬ .03) and early rebleeding in 24% vs. 7% (P ‫؍‬ .03), respectively. Transfusional requirements were significantly higher in the SMT group, while the incidence of complications was lower (8% vs. 24%; P ‫؍‬ .029). In the multivariate analysis, the presence of shock at admission and active bleeding during endoscopy were the variables that better predicted the failure of therapy with SMT alone. Mortality at 6 weeks was similar. These data demonstrate that the addition of sclerotherapy significantly improves the efficacy of SMT alone for the treatment of acute variceal bleeding, although it also increases the rate of complications. Patients with shock and those with active bleeding are more likely to benefit from this combined therapy. (HEPATOLOGY 1999;30:384-389.)Despite recent therapeutic advances, acute esophageal variceal hemorrhage is still one of the leading causes of death in patients with cirrhosis. 1 Sclerotherapy is widely used as the main emergency treatment in most institutions. Randomized, controlled trials have shown that emergency sclerotherapy (EST) is effective for the control of acute esophageal variceal bleeding, 1 and meta-analysis of comparative studies has suggested that it fares better than balloon tamponade and vasopressin. 1 It has also been suggested that EST reduces the frequency of early rebleeding, 1 which is an important indicator of death risk. 2 However, EST is not always successful, it is associated with a non-negligible rate of serious complications, and it requires a skilled endoscopist, a necessity not always available. 3 Somatostatin (SMT) was introduced for the treatment of acute variceal hemorrhage because of its capacity to decrease portal pressure and collateral splanchnic blood flow, without the adverse effects of vasopressin on the systemic circulation. 4 One placebo-controlled trial failed to show any beneficial effect with SMT, 5 although the high spontaneous success rate observed with placebo suggests that some inadvertent bias could occur in this study. 5 Furthermore, several randomized, controlled trials have shown that SMT is more effective than placebo, 6 and as effective as vasopressin, 7,8 ...

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“…However, exact mechanism of the action remains unknown. In a double-blind, placebo-controlled hemodynamic study, Cirera et al (1995) demonstrated that a bolus injection of SMT caused a rapid decrease in portal pressure gradient (52%) and azygos blood flow (45%). Vanheule et al (2008) suggested that the very rapid onset effect of SMT is indicative of a direct action involving the vascular smooth muscle cell.…”

Section: Discussionmentioning

confidence: 99%

“…Somatostatin (SMT) has been proposed as a treatment for variceal gastrointestinal bleeding because of its ability to decrease portal pressure without significant adverse systemic effects. The effect of somatostatin is possibly mediated through its ability to cause a splanchnic vasoconstriction and reduction of splanchnic blood flow (Carsson et al, 1994;Cerini et al, 1998;Cirera et al, 1995;Jenkins et al, 1998;Saruc et al, 2003;Sonnenberg et al, 1981). To our knowledge there are no data on the use of SMT in traumatic intra-abdominal hemorrhages.…”

Section: Introductionmentioning

confidence: 99%

Does Somatostatin Decrease Hemorrhage From Injured Liver in Rats?

Akçora¹,

Altuğ²,

Fansa³

et al. 2009

jecm

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In portal hypertensive patients, somatostatin (SMT) and octreotide have been widely used to decrease variceal bleeding because of its splanchnic hypoperfusion effect. The aim of this study was to explore the effects of somatostatin treatment for decreasing blood loss of uncontrolled liver hemorrhage model in rats.Twenty-one male rats were divided into 3 groups including group 1; nontreatment, group 2; isotonic saline infusion and group 3; isotonic saline plus SMT infusion. Intra-abdominal bleeding was induced by transection of median lobe of liver. Mean arterial pressures (MAP), amount of intra-peritoneal blood collection and hematocrit (Hct) changes were evaluated for 60 minutes.There was no difference in the MAP changes between the groups until 25th minute. Thereafter, MAP remained similar in the group 1 while gradually increased (P< 0.05) in the group 2 and 3. There was no statistically significant difference between the groups 2 and 3. End of study, the highest Hct value was determined in the nontreatment group (41.0 ± 3.26 %) and it significantly different from other two groups. We found increase of Htc value in the group 3 (32.3 ± 2.75 %) when compared with group 2 (29.7 ± 4.19 %), but it was not statistically significant. The highest intra-peritoneal blood volume was determined in group 2. We found decrease of the hemorrhage in the group 3 when compared with the group 2, but it was not statistically significant. Somatostatin using has a tendency, although not statistically significant, to decrease of intraperitoneal hemorrhage from liver in the rat model.

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Effects of bolus injections and continuous infusions of somatostatin and placebo in patients with cirrhosis: A double-blind hemodynamic investigation

Cited by 79 publications

References 31 publications

Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices

Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices

Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding: A prospective randomized trial

Does Somatostatin Decrease Hemorrhage From Injured Liver in Rats?

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