Prospective randomised study of effect of octreotide on rebleeding from oesophageal varices after endoscopic ligation

Sung, Joseph J.Y.; Chung, S. C. S.; Yung, Man Yee; Lai, Chi Wai; Lau, James Y.; Lee, Y. T.; Leung, Vyl; Li, M. K. K.; Li, A. K. C.

doi:10.1016/s0140-6736(95)92840-5

Cited by 187 publications

(123 citation statements)

References 12 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…[14][15][16][17][18] The meta-analysis of these trials showed no differences between the 2 treatments in terms of bleeding control, in hospital rebleeding rate, or mortality. 1 On the other hand, the results of recent randomized, controlled trials have shown that the association of vasoactive drugs such as octreotide, [19][20][21] SMT, 22 or terlipressin 21 significantly improves the efficacy of endoscopic treatment alone for the control of acute variceal bleeding, with a similar incidence of side-effects and overall mortality. [19][20][21][22] However, whether the combination of EST with vasoactive drugs may improve the efficacy of pharmacological treatment alone has not been adequately investigated.…”

mentioning

confidence: 99%

“…1 On the other hand, the results of recent randomized, controlled trials have shown that the association of vasoactive drugs such as octreotide, [19][20][21] SMT, 22 or terlipressin 21 significantly improves the efficacy of endoscopic treatment alone for the control of acute variceal bleeding, with a similar incidence of side-effects and overall mortality. [19][20][21][22] However, whether the combination of EST with vasoactive drugs may improve the efficacy of pharmacological treatment alone has not been adequately investigated. The present study was performed to assess whether the addition of EST to SMT treatment improves the results of SMT alone in the management of acute esophageal variceal bleeding.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 1999

View full text Add to dashboard Cite

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 ...

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 1999

View full text Add to dashboard Cite

show abstract

“…A utilização isolada de somatostatina/octreotide foi comparada ao seu uso combinado à ligadura elástica de varizes (37) e à escleroterapia (5) e esta associação mostrou eficácia superior, reduzindo a taxa de ressangramento, embora sem traduzir melhora na sobrevida. No entanto, recentemente (41) , foi demonstrado que o uso combinado só apresenta vantagens à utilização isolada de somatostatina em pacientes com alto risco de insucesso com o uso da terapia farmacológica, ou seja, em pacientes em choque ou naqueles com sangramento ativo durante a endoscopia.…”

unclassified

Escleroterapia versus somatostatina na hemorragia digestiva alta por ruptura de varizes esofágicas

Ramires

Zils

Mattos

2000

Arq. Gastroenterol.

View full text Add to dashboard Cite

INTRODUÇÃOA prevalência de varizes gastroesofágicas (VGE) em pacientes cirróticos é de aproximadamente 60%. Uma vez presentes, observa-se risco médio de sangramento de 32% em 2 anos. Por outro lado, o risco de ressangramento é muito alto, atingindo um pico na primeira semana, mas permanecendo elevado até o terceiro mês, com índices de até 70% em um ano (21,22) . Paralelamente, observa-se que a mortalidade do paciente com sangramento é de 30% a 50% dos casos, ou seja, maior do que três vezes aquela por sangramento digestivo de outra causa (6,15,29,30) . Em decorrência da freqüência da hemorragia digestiva alta (HDA) por ruptura de VGE e do mau prognóstico que a

show abstract

“…[9][10] However, whether it significantly reduces 6-week rebleeding or not is still unclear. 9 Aiming at reducing early rebleeding, administration of somatostatin, 11 octreotide, [12][13] or terlipressin 14 has been prolonged for as long as 5 [11][12][13] to 7 14 days after bleeding control, and ␤-blockers have been administered as soon as 24 15 to 72 hours [16][17] after bleeding cessation. However, so far none of these treatments has been shown to significantly reduce the risk of rebleeding within 6 weeks.…”

mentioning

confidence: 99%

“…9 Also, data on emergency banding ligation of varices is insufficient. 18 Octreotide has the same hemodynamic effects of native somatostatin [19][20][21] and is effective in controlling variceal bleeding [12][13]22 virtually without side effects. Moreover it is suitable for long-term treatment because it has a relatively long half-life 23 and can be administered subcutaneously.…”

mentioning

confidence: 99%

Octreotide compared with placebo in a treatment strategy for early rebleeding in cirrhosis. A double blind, randomized pragmatic trial

et al. 1998

View full text Add to dashboard Cite

␤-Blockers and sclerotherapy prevent long-term upper digestive rebleeding in cirrhosis but they seem ineffective for early rebleeding. We compared octreotide with a placebo for the prevention of early rebleeding in cirrhotic patients. After control of acute upper digestive bleeding, 262 consecutive cirrhotic patients were randomized to octreotide 100 g subcutaneously three times a day for 15 days (n ‫؍‬ 131) or to the placebo (n ‫؍‬ 131), in a double blind pragmatic trial in which ␤-blockers and/or sclerotherapy were allowed together with the experimental treatment. Separate randomization and analysis were performed according to whether patients were eligible for ␤-blockers and/or sclerotherapy (101 placebo, 97 octreotide) or not (30 placebo, 34 octreotide). Rebleeding within 15 days was the primary measure of treatment efficacy; 6-week rebleeding rate was also assessed as a secondary measure. Fifteen-day cumulative proportions of patients rebleeding were 28% in the placebo group and 24% in the octreotide group (P ‫؍‬ .40); corresponding figures among the 198 patients eligible to ␤-blockers and/or sclerotherapy were 26% and 16% (P ‫؍‬ .05) and among the 64 not eligible for these treatments 33% and 49% (P ‫؍‬ .29). Among patients eligible to ␤-blockers and/or sclerotherapy, a significant reduction of rebleeding episodes (35 vs. 18, P ‫؍‬ .03), blood transfusions (75 vs. 50, P ‫؍‬ .04), and days of stay in hospital (1,544 vs. 1,190, P ‫؍‬ .0001) was also found in the octreotide group: this beneficial effect was confirmed 6 weeks after randomization. Following upper digestive bleeding in cirrhosis, almost 50% of patients rebleed and 30% die within 6 weeks.

show abstract

Prospective randomised study of effect of octreotide on rebleeding from oesophageal varices after endoscopic ligation

Cited by 187 publications

References 12 publications

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

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

Escleroterapia versus somatostatina na hemorragia digestiva alta por ruptura de varizes esofágicas

Octreotide compared with placebo in a treatment strategy for early rebleeding in cirrhosis. A double blind, randomized pragmatic trial

Contact Info

Product

Resources

About