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

Wang, Chao; Han, Juan; Liang, Xiao; Jin, Chang'e; Li, Miaosi; Yang, Zhaohui

doi:10.1007/s12072-014-9594-9

Cited by 28 publications

(26 citation statements)

References 39 publications

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“…There is no difference between vasopressin/terlipressin and SSAs in the prevention of re-bleeding after the initial treatment of bleeding esophageal varices [169]. Treatment with SSAs should be started as soon as possible and in conjunction with endoscopic treatment.…”

Section: Acute Bleeding From the Gastrointestinal Tractmentioning

confidence: 99%

Somatostatin Analogs in Clinical Practice: A Review

Gomes-Porras

Cárdenas-Salas

Álvarez-Escolá

2020

IJMS

163

136

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Somatostatin analogs are an invaluable therapeutic option in the diagnosis and treatment of somatotropinomas, thyrotropinomas, and functioning and non-functioning gastroenteropancreatic neuroendocrine tumors. They should also be considered an effective and safe therapeutic alternative to corticotropinomas, gonadotropinomas, and prolactinomas resistant to dopamine agonists. Somatostatin analogs have also shown to be useful in the treatment of other endocrine diseases (congenital hyperinsulinism, Graves' orbitopathy, diabetic retinopathy, diabetic macular edema), non-endocrine tumors (breast, colon, prostate, lung, and hepatocellular), and digestive diseases (chronic refractory diarrhea, hepatorenal polycystosis, gastrointestinal hemorrhage, dumping syndrome, and intestinal fistula).

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Section: Acute Bleeding From the Gastrointestinal Tractmentioning

confidence: 99%

Somatostatin Analogs in Clinical Practice: A Review

Gomes-Porras

Cárdenas-Salas

Álvarez-Escolá

2020

IJMS

163

136

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“…Although the use of vasoactive agents for the reduction in portal pressure and control of rebleeding specific to gastric variceal bleeding is unavailable in literature, the same line of supportive therapy as for esophageal variceal bleeding, is currently recommended. Wang et al in their systematic review and meta-analysis showed that there was no difference between vasopressin/terlipressin and somatostatin/octreotide in the prevention of re-bleeding after the initial treatment of bleeding esophageal varices [ 30 ]. Antibiotic prophylaxis, lactulose for the prevention of hepatic encephalopathy along with other supportive measures that include varying degrees of organ support depending on the severity of systemic dysfunction is mandated in GV bleed [ 31 ].…”

Section: Treatmentmentioning

confidence: 99%

Beyond the scope and the glue: update on evaluation and management of gastric varices

et al. 2020

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Gastric varices are encountered less frequently than esophageal varices. Nonetheless, gastric variceal bleeding is more severe and associated with worse outcomes. Conventionally, gastric varices have been described based on the location and extent and endoscopic treatments offered based on these descriptions. With improved understanding of portal hypertension and the dynamic physiology of collateral circulation, gastric variceal classification has been refined to include inflow and outflow based hemodynamic pathways. These have led to an improvement in the management of gastric variceal disease through newer modalities of treatment such as endoscopic ultrasound-guided glue-coiling combination therapy and the emergence of highly effective endovascular treatments such as shunt and variceal complex embolization with or without transjugular intrahepatic portosystemic shunt (TIPS) placement in patients who are deemed ‘difficult’ to manage the traditional way. Furthermore, the decisions regarding TIPS and additional endovascular procedures in patients with gastric variceal bleeding have changed after the emergence of ‘portal hypertension theories’ of proximity, throughput, and recruitment. The hemodynamic classification, grounded on novel theories and its cognizance, can help in identifying patients at baseline, in whom conventional treatment could fail. In this exhaustive review, we discuss the conventional and hemodynamic diagnosis of gastric varices concerning new classifications; explore and illustrate new ‘portal hypertension theories’ of gastric variceal disease and corresponding management and shed light on current evidence-based treatments through a ‘new’ algorithmic approach, established on hemodynamic physiology of gastric varices.

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“…To date, cumulative randomized prospective studies had been carried out to compare the effectiveness of terlipressin and octreotide for the control of acute variceal bleeding 7 , 15 , 17 – 21 . All of them concluded that the efficiency of terlipressin and octreotide in controlling variceal bleeding was not different in terms of the hemostatic effect, safety, hospital stay, or mortality 15 , 21 .…”

Section: Discussionmentioning

confidence: 99%

No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment

Hung

Tsai

Tseng

et al. 2016

European Journal of Gastroenterology &Amp; Hepatology

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ObjectiveTo study the differences in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding (EVB) and renal functional impairment (RFI).MethodsThe National Health Insurance Database, part of the Taiwan National Health Insurance Program, was used to enroll cirrhotic patients who had received endoscopic variceal ligation plus somatostatin or terlipressin for EVB and who were hospitalized between 1 January 2007 and 31 December 2010. The differences in mortality between the two vasoactive agents were compared and the risk factors for 30-day mortality because of EVB were identified.ResultsA total of 2324 cirrhotic patients with EVB were enrolled. The 30-day mortality data showed no significant differences between the somatostatin and the terlipressin groups (P=0.232). The risk of 30-day mortality was significantly higher in male patients [hazard ratio (HR): 1.50, P=0.002] and patients with hepatic encephalopathy (HR: 1.82, P<0.001), ascites (HR: 1.32, P=0.008), bacterial infections (HR: 2.10, P<0.001), hepatocellular carcinoma (HR: 2.09, P<0.001), and RFI (HR: 3.89, P<0.001). A subgroup analysis of cirrhotic patients with RFI was carried out. The overall 30-day mortality was higher in patients treated with somatostatin than in those treated with terlipressin (52.6 vs. 42.3%), but the difference failed to reach significance (adjust HR: 1.49, 95% confidence interval: 0.94–2.37, P=0.091).ConclusionRFI was the most important risk factor for 30-day mortality in EVB patients. Terlipressin and somatostatin had similar effects on 30-day mortality in cirrhotic patients with EVB and RFI.

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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

Abstract: There is no difference between vasopressin/terlipressin and somatostatin/octreotide in prevention of re-bleeding after the initial treatment of bleeding esophageal varices.

Cited by 28 publications

References 39 publications

Somatostatin Analogs in Clinical Practice: A Review

Somatostatin Analogs in Clinical Practice: A Review

Beyond the scope and the glue: update on evaluation and management of gastric varices

No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment

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