Randomised trial of octreotide for long term management of cirrhosis after variceal haemorrhage

Abstract

Objective: To assess the efficacy of long term octreotide as adjuvant treatment to programmed endoscopic sclerotherapy after acute variceal haemorrhage in cirrhotic portal hypertension. Design: Randomised clinical trial. Setting: University hospital. Subjects: 32 patients with cirrhotic portal hypertension. Interventions: Programmed injection sclerotherapy with subcutaneous octreotide 50 g twice daily for 6 months, or programmed injection sclerotherapy alone. Main outcome measures: Episodes of recurrent variceal bleeding and survival. Results: Significantly fewer patients receiving combined octreotide and sclerotherapy had episodes of recurrent variceal bleeding compared with patients given sclerotherapy alone (1/16 v 7/16; P = 0.037, Fisher's exact test), and their survival was significantly improved (P < 0.02, log rank test); this improvement was maintained for 12 months after the end of the study. Combined treatment also resulted in a sustained decrease in portal pressure (median decrease − 6.0 mm Hg, interquartile range −10 to − 4.75 mm Hg, P = 0.0002) compared with sclerotherapy alone (median increase 1.5 mm Hg, interquartile range 0.25 to 3.25 mm Hg), as well as a significant improvement in liver function as assessed by plasma concentrations of bilirubin, albumin, and alanine aminotransferase and by hepatocyte metabolism of aminopyrine labelled with carbon-14. Conclusion: Long term octreotide may be a valuable adjuvant to endoscopic sclerotherapy for acute variceal haemorrhage in cirrhotic portal hypertension.

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

“…10,11 However, haemodynamic and clinical data are not so consistent when other agents such as octreotide (OCT) are used. The effects of OCT on variceal pressure are controversial as some studies showed a transient decrease, 12 whereas other studies showed no changes or even increases after OCT administration. 13 Vasoactive drugs facilitate endoscopic therapy and improve the efficacy of both EIS and EBL.…”

Somatostatin receptor expression, tumour response, and quality of life in patients with advanced hepatocellular carcinoma treated with long-acting octreotide

“…Since prophylactic octreotide can prevent bleeding in high-risk patients (Jenkins et al, 1997), octreotide LAR might reduce morbidity and mortality through this mechanism. In our trial, gastrointestinal bleeding occurred in four patients (one peptic ulcer, three varices) with a total follow-up approaching 4000 patient-months.…”

“…In patients with portal hypertension, octreotide has been used extensively in the management of acute variceal bleeding and other complications, where it reduces portal blood pressure in patients with poor liver function (Jenkins et al, 1997). Although the benefit observed by Kouroumalis et al (1998) may be a direct anticancer effect mediated by specific receptors on HCC cells, its effects on portal hypertension may also reduce the frequency of variceal bleeding.…”

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

“…It is of interest, in this regard, that Child C patients were 25% and 28% respectively in the positive studies by Besson and colleagues 13 and by Jenkins and colleagues. 37 Mortality was not influenced by octreotide either in the Cumulative proportions of patients free of rebleeding in the group of 198 patients eligible for ␤-blockers and/or sclerotherapy, according to the randomized treatment: octreotide (n ϭ 97) and placebo (n ϭ 101). The vertical dashed line indicates the 15-day treatment period.…”

“…with sclerotherapy for acute variceal bleeding, and more recently Jenkins and colleagues 37 reported a significantly beneficial effect of long-term subcutaneous octreotide associated with sclerotherapy.…”