A prospective randomised controlled clinical trial comparing somatostatin and vasopressin in controlling acute variceal haemorrhage.

Jenkins, S. A.; Baxter, J. N.; Corbett, W. A.; Devitt, P.; Ware, James H.; Shields, R.

doi:10.1136/bmj.290.6464.275

Cited by 195 publications

(49 citation statements)

References 15 publications

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“…[6][7][8]10,12,13 It has been demonstrated that bolus injections of SMT cause a rapid and more pronounced reduction of portal pressure and azygos blood flow than those observed with continuous infusion. 26 These marked hemodynamic effects may explain, at least in part, the higher efficacy reported in clinical trials using additional boluses.…”

Section: Discussionmentioning

confidence: 99%

“…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 vasopressin associated with nitroglycerin, 9 terlipressin, 10,11 and balloon tamponade, 12,13 with fewer side-effects in most of these studies. Both SMT and octreotide, a synthetic SMT analogue, have shown an efficacy similar to that of EST for the control of acute variceal bleeding, [14][15][16][17] and for the prevention of early rebleeding, 18 while morbidity significantly decreased.…”

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confidence: 99%

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

et al. 1999

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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 ...

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Section: Discussionmentioning

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

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“…Estudos realizados (26,27,32,34,36,40) têm demonstrado que a somatostatina ou seu análogo sintético, o octreotide, é tão eficaz quanto a escleroterapia, tratamento considerado padrão na maioria dos centros médicos, no controle da HDA por ruptura de varizes esofágicas ou na prevenção do ressangramento precoce (17) . Deve-se, no entanto, ressalvar o fato de que o octreotide parece não ter a mesma eficácia que a somatostatina (2,4,9) .…”

Section: Discussionunclassified

“…As complicações foram significativamente mais freqüentes (19% x 9%) e mais graves no grupo da escleroterapia. A despeito de JENKINS et al (26) , em avaliação inicial, encontraram dados que se superpõem aos anteriores, quando avaliaram maior casuística (27) e obtiveram controle do sangramento em 48 h (85% no grupo do octreotide e 82% no da escleroterapia) e mortalidade em 5 dias semelhantes, porém observaram maior mortalidade (31% x 17%) em 60 dias e número maior de complicações no grupo do octreotide, embora sem significância estatística.…”

Section: Discussionunclassified

“…Estudos randomizados mostraram que a somatostatina e seu análogo sintético -o octreotide -são mais eficazes que a vasopressina (8,15,29) e têm eficácia semelhante à terlipressina (18,31,39,42) , ao balão de Sengstaken-Blakemore (1,25) e à escleroterapia (17,26,27,32,34,36,40) no controle do sangramento agudo por varizes esofágicas, tendo como principal mérito o fato de seus efeitos colaterais, quando presentes, serem discretos (12) .…”

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

Ramires

Zils

Mattos

2000

Arq. Gastroenterol.

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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

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Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis

Roberts

Best

Freeman

et al. 2021

Cochrane Database of Systematic Reviews

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A prospective randomised controlled clinical trial comparing somatostatin and vasopressin in controlling acute variceal haemorrhage.

Abstract: References

Cited by 195 publications

References 15 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

Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis

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