A Prospective Randomized Controlled Clinical Trial Comparing the Effects of Somatostatin and Vasopressin for Control of Acute Variceal Bleeding in the Patients with Liver Cirrhosis

Abstract

Background:Acute variceal bleeding is a serious complication of liver cirrhosis, which has an attendant mortality of approximately 60% over two years, and a variety of treatments, such as balloon tamponade, endoscopic varix ligation, sclerotherapy, histoacryl injection and vasoactive drugs, have been used. The aims of the present trial were to compare the effectiveness and complications of somatostatin and vasopressin in the treatment of acute variceal bleeding.Methods:Forty-three cirrhotic patients, with endoscopically proven acute variceal bleeding, were included in this trial. Both drugs were given as continuous intravenous infusions for 48 hours. Twenty patients received the somatostatin (250 mcg per hr after a bolus of 50 mcg) and twenty-three the vasopressin (0.4 units per min).Results:There were no significant differences between the two groups in relation to age, sex, etiology of cirrhosis, Child-Pugh classification, characteristics of bleeding episode, laboratory findings before randomization and units of transfused blood during therapy. Rebleeding, within 6 hours after beginning of therapy, was regarded as failure to control initial bleeding, and was observed in 3 (13.0%) of the patients who received vasopressin and in 1 (5.0%) treated with somatostatin (p>0.05). Five patients in both the somatostatin (25.0%) and vasopressin (21.7%) groups rebled during the first 5 days following the initial therapy (p>0.05). Meaningful complications related to the use of vasopressin were observed in 5 patients (chest pain or abdominal pain requiring nitroglycerin), but no complications were associated with the use of somatostatin (p<0.05). The mortalities during hospitalization were similar in both the treatment groups. Two of the vasopressin and 1 of the somatostatin group died due to the uncontrolled rebleeding, and 1 of the vasopressin group died due to hepatic failure (2 weeks later after therapy).Conclusion:This study showed no differences in the effectiveness of somatostatin and vasopressin, but the somatostatin group had a lower risk of the complications.

Comparison of drugs facilitating endoscopy for patients with acute variceal bleeding: a systematic review and network meta-analysis

“…One hundred seventy-seven unique studies were identified in total using the search strategy after which we reviewed 60 studies with full-texts and we included 14 RCTs with potential eligibility at last in this network meta-analysis (12,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Literature search process was demonstrated in Figure 1.…”

Meta‐analysis: vasoactive medications for the management of acute variceal bleeds

“…We screened 3011 citations, and 128 were selected for full‐text retrieval. Of these, 30 articles were selected for final inclusion into the vasoactive medication vs. placebo systematic review and 27 articles were included in the medication vs. medication systematic review (see Figure ).…”

Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding: a systematic review and meta-analysis

“…Thus, six studies were included in the metaanalysis [32,[34][35][36][37][38]. All six studies were RCTs, and (Table 3).…”

“…The remaining 58 articles were assessed for eligibility and 49 were excluded (Fig. 1); thus nine studies were included in the qualitative synthesis [18,[32][33][34][35][36][37][38][39].…”