Effects of a somatostatin analogue SMS 201-995 on hepatic haemodynamics in the pig and on intravariceal pressure in man

Abstract

The effects of a somatostatin analogue, SMS 201-995, on hepatic haemodynamics in the pig and on intravariceal pressure in man were studied. An infusion of 250 micrograms/h SMS 201-995 significantly reduced portal pressure, portal venous flow and hepatic artery flow in the pig. These changes in hepatic haemodynamics were accompanied by a reduction in cardiac output, a reflex slowing of the heart and an increase in arterial blood pressure. Splanchnic vascular resistance was increased following SMS 201-995 administration but hepatic vascular resistance remained unchanged. Administration of 50 micrograms SMS 201-995 reduced the intravariceal pressure from 27.4 +/- 2.5 to 15.8 +/- 2.1 mmHg in 9 patients with cirrhosis and portal hypertension. Administration of 50 micrograms SMS 201-995 also reduced portal pressure from 29 to 22 mmHg in a patient undergoing an elective portacaval shunt. These results suggest that SMS 201-995 may be of value in the control of bleeding oesophageal varices. Furthermore, because of its prolonged duration of action SMS 201-995 may be useful in the long term management of portal hypertension in patients with cirrhosis.

Effects of Different Octreotide Dosages on Splanchnic Hemodynamics and Glucagon in Healthy Volunteers

“…As a result octreotide was shown to lower azygos blood flow [3]and variceal pressure [4]. Therefore, octreotide has been evaluated for both the adjuvant medical treatment of acute variceal bleeding [5, 6, 7]and the prophylaxis of rebleeding [8].…”

Early Propranolol Administration Does Not Prevent Development of Esophageal Varices in Cirrhotic Rats

“…However, the results of those studies, which were mainly based on hemodynamic measurements and especially on calculation of the portosystemic shunt degree, have been criticized as being possibly affected by a number of imponderable and in many cases unknown factors [20][21][22] . It is therefore understood why similar studies from various research centers often resulted in completely different conclusions [23][24][25][26][27] . This study was designed in order to avoid similar problems by directly investigating lower esophageal pathology as shown in a previous study conducted in our department, where early octreotide administration seemed to attenuate the development of esophageal varices in cirrhotic rats [9] .…”

Somatostatin for Upper Gastrointestinal Hemorrhage and Pancreatic Surgery

“…Bolus injection appears to have important hemodynamic effects as compared to constant infusion (table 5), and may be the preferred method of administration [57]. Octreotide also can significantly reduce portal pressure [58,59], collateral blood flow [60], and AzBF [61] in cirrhotics -surrogate markers of variceal blood flow, but, like for natural somatostatin, there are some studies reporting no hemodynamic effect. A recent study [62] actually showed that intravenous bolus injection of octreotide does increase intraesophageal variceal pressure (IEVP), thus suggesting that this mode of administration is not appropriate as a first-line therapy for variceal hemorrhage.…”