3543 A prospective randomized trial of octreotide plus sclerotherapy for acute variceal bleeding. a multicentric study.

Abstract

Comparative studies have shown that either somatostatin and octreotide (OCT)are as effective as sclerotherapy (ES). AIM: To assess whether combined therapy with OCT and sclerotherapy is superior to OCT alone for the control of acute variceal bleeding and the prevention of earley rebleeding. METHODS: During a two year period patients admitted with upper GI bleeding and in who cirrhosis and portal hypertension were suspected, received a continuous infusion of OCT (50μg/hr with additional bolus of 50μg every 6 hr.). Emergency endoscopy was performed 1 to 5 hours after starting OCT. When endoscopy disclosed variceal bleeding patients were randomized to receive ES or no ES, which was carried out during the same endoscopic procedure. OCT infusion was continued for 5 days. Variceal bleeding was diagnosed when there was: 1) active bleeding or 2) clot or fibrin plug over a varix, or 3) varices with no other potential source of bleeding. Therapeutic failure was defined if there was: 1) persistent bleeding (within the first 6hr after admission) or 2) early rebleeding (during a 5-day period). RESULTS: 75 patients were included (17% were Pugh's class C and 47% had alcoholic cirrhosis). 37pts were treated with OCT alone and 38 with OCT plus ES. Mean age, sex, Pugh's class, cirrhosis etiology were similar in both groups Therapeutic failure ocurred in 7 pts. of the OCT group and 7 pts. of OCT plus ES group. There were no differences in persistent or early rebleeding between both groups. Major complications were more frequent with the combined therapy (5 vs 7). 8% of the patients died whithin a six week period, without significant differences between both groups. CONCLUSIONS: There where no significant differences between combined therapy with octreotide plus sclerotherapy versus octreotide alone for the control of acute variceal bleeding and survival.