A comparison of two different dosages of somatostatin combined with sclerotherapy for the treatment of acute esophageal variceal bleeding: a prospective randomized trial Comparación de dos dosis diferencias de somatostatina para el tratamiento de sangrado agudo de varices esofágicas: ensayo clínico randomizado

Abstract

Background: the association of somatostatin (SMT) with endoscopic therapy in patients with cirrhosis and variceal bleeding significantly improves the control of the bleeding episode, and hemodynamic data have shown that a dosage of 500 µg/h allows a more marked reduction of portal pressure versus the usual dosage of 250 µg/h. Aim: to assess if the 500 µg/h dosage is associated with an improved outcome. Methods: sixty-two patients with variceal bleeding were included in the study. Patients were randomized to receive the usual dosage of SMT (group I: 250 µg/h), or a double dosage (group II: 500 µg/h), together with emergency endoscopic sclerotherapy. Results: the control of the bleeding episode was similar in both groups of patients. Early rebleeding was less frequent in patients receiving double vs. single dosage of SMT (p = 0.06). When considering patients with advanced liver disease (Child-Pugh B or C) early rebleeding was significantly less frequent in patients receiving the 500 µg/h dose of SMT (39 vs. 13%, p = 0.03). Conclusions: the perfusion of higher doses of SMT (500 µg/h) in association with emergency sclerotherapy in patients with cirrhosis and esophageal hemorrhage significantly decreases the rate of early rebleeding in patients with more advanced stages of liver disease.

Keywords

• Cirrhosis
• Portal hypertension
• Somatostatin
• Variceal bleeding