Terlipressin vs. Octreotide in Bleeding Esophageal Varices

Abstract

To the Editor: Th e study by Abid et al. (1) is important as both terlipres-sin and octreotide are widely used in the treatment of bleeding esophageal varices. A very low failure rate was observed, although the terlipressin dose was lower than recommended (1 mg verey 6 h). Th is is surprising, as previous studies have shown that strict adherence to the Baveno II and III cri-teria would increase the risk of failure to control bleeding due to pulse rate changes (2) . In the intention-to-treat analyses, the failure to control bleeding was 5.9 % , which is < 50 % h e ot f fi nd-ings in other studies. Th e rate of fail-ure to control bleeding in a study using he t Bno vea I – II eria t cri was 14.6 % (3) , and it was 13.7 % in a study that used a composite of the Baveno II – IV criteria (4) . Similarly, mortality was very low, 5.5 and 4.3 % , respectively. Mortality from bleeding esophageal varices has decreased in the past decades with the introduction of modern treatments, but even in leading centers, mortality is still ~ 15 % (5) . Overallh, e t patients in hb otgroups in this study had a better prog-nosis on all outcomes than did patients in studies with similar interventions. Th is raises the question of whether these data can be extended to patients with severe bleeding who are known to have much higher rates of failure to control bleeding and mortality. Furthermore, at some points, the study is diffi cult to interpret for the reader, and comparisons with other studies and extensions to clinical practice are hampered because of the lack of defi nitions and data on key