Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices

Vlachogiannakos, John; Kougioumtzian, A.; Triantos, Christos; Viazis, Nikos; Sgouros, Spiros; Manolakopoulos, Spilios; Saveriadis, A.; Markoglou, Costas; Economopoulos, T.; Karamanolis, Dimitrios G.

doi:10.1111/j.1365-2036.2007.03539.x

Cited by 17 publications

(7 citation statements)

References 39 publications

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“… 18 documented that short‐term prognosis in alcoholic cirrhotics with variceal bleeding was independently associated with portohepatic gradient measured within 48 h of admission. These results have been confirmed by several others 19–23 …”

Section: Acute Variceal Bleedingsupporting

confidence: 86%

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Review article: the therapeutic and prognostic benefit of portal pressure reduction in cirrhosis

Triantos

Nikolopoulou

Burroughs

2008

Aliment Pharmacol Ther

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Section: Acute Variceal Bleedingsupporting

confidence: 86%

“…In addition Vlachogiannakos et al. 23 showed that somatostatin, but not octreotide, effectively prevented the postendoscopic increase in HVPG. The treatment failure (i.e.…”

Section: Acute Variceal Bleedingmentioning

confidence: 99%

Review article: the therapeutic and prognostic benefit of portal pressure reduction in cirrhosis

Triantos

Nikolopoulou

Burroughs

2008

Aliment Pharmacol Ther

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“…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 ).…”

Section: Resultsmentioning

confidence: 99%

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

Wells

Chande

Adams

et al. 2012

Aliment Pharmacol Ther

213

136

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Summary Background Vasoactive medications such as vasopressin, somatostatin and their analogues (terlipressin, vapreotide and octreotide) are commonly used for the treatment of acute variceal bleeding. However, the risks and benefits of these interventions are not well understood. Aim To undertake a meta‐analysis of the efficacy of vasoactive medications in patients having acute variceal bleeds. Methods Randomised controlled trials (RCTs) of vasopressin, somatostatin and their analogues, administered to patients with acute variceal bleeds were identified based on systematic searches of nine electronic databases and multiple sources of grey literature. Results The search identified 3011 citations, and 30 trials with a total of 3111 patients met eligibility criteria. The use of vasoactive agents was associated with a significantly lower risk of 7‐day mortality (RR 0.74; 95% CI 0.57–0.95; P = 0.02; I2 = 0%; moderate quality of evidence), and a significant improvement in haemostasis (RR 1.21, 95% CI 1.13–1.30; P < 0.001; I2 = 28%; very low quality of evidence), lower transfusion requirements (pooled mean difference −0.70 units of blood transfused, 95% CI −1.01 to −0.38; P < 0.001; I2 = 82%; moderate quality of evidence), and a shorter duration of hospitalisation (pooled mean difference −0.71 days; 95% CI −1.23 to −0.19; P = 0.007; I2 = 0%; low quality of evidence). Studies comparing different vasoactive agents did not show a difference in efficacy, although the quality of evidence was very low. Conclusions The use of vasoactive agents was associated with a significantly lower risk of acute all‐cause mortality and transfusion requirements, and improved control of bleeding and shorter hospital stay. Studies comparing different vasoactive medications failed to demonstrate a difference in efficacy.

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“…Most studies described that patients with variceal bleeding almost have an HVPG of >12 mmHg 37,38. Short-term prognosis in alcoholic cirrhosis with variceal bleeding was related with porto-hepatic gradient measured within 48 hours of admission 39,40. In other study, an initial HVPG of >20 mmHg was associated with a significantly longer hospital stay, greater transfusion requirements, and worse survival (1-year mortality: 64% vs. 20%, P <0.002) 24.…”

Section: Introductionmentioning

confidence: 99%

Hepatic venous pressure gradient: clinical use in chronic liver disease

Suk

2014

Clin Mol Hepatol

117

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Portal hypertension is a severe consequence of chronic liver diseases and is responsible for the main clinical complications of liver cirrhosis. Hepatic venous pressure gradient (HVPG) measurement is the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to >10 mmHg. In this condition, the complications of portal hypertension might begin to appear. HVPG measurement is increasingly used in the clinical fields, and the HVPG is a robust surrogate marker in many clinical applications such as diagnosis, risk stratification, identification of patients with hepatocellular carcinoma who are candidates for liver resection, monitoring of the efficacy of medical treatment, and assessment of progression of portal hypertension. Patients who had a reduction in HVPG of ≥20% or to ≤12 mmHg in response to drug therapy are defined as responders. Responders have a markedly decreased risk of bleeding/rebleeding, ascites, and spontaneous bacterial peritonitis, which results in improved survival. This review provides clinical use of HVPG measurement in the field of liver disease.

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Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices

Abstract: SUMMARY BackgroundHepatic venous pressure gradient (HVPG) increases significantly after endoscopic therapy in patients with bleeding oesophageal varices, which may precipitate further haemorrhage. Whether vasoactive drugs can suppress these changes remains unknown.

Cited by 17 publications

References 39 publications

Review article: the therapeutic and prognostic benefit of portal pressure reduction in cirrhosis

Review article: the therapeutic and prognostic benefit of portal pressure reduction in cirrhosis

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

Hepatic venous pressure gradient: clinical use in chronic liver disease

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