Selective Intra-arterial Vasopressin Infusion for Upper Gastrointestinal Tract Hemorrhage

Role of Vasoactive Drugs in the Treatment of Bleeding Oesophageal Varices

“…At pharmacological doses, it induces smooth muscle contraction, particularly in splanchnic arterioles, vasoconstriction of which reduces blood inflow into the portal venous system and thereby lowers the portal venous pressure. Vasopressin was compared with non-active treatment or placebo in 4 randomised controlled trials [11][12][13][14], including only 157 patients (table 1). In two of these trials the intra-arterial route of administration was used [12,13].…”

“…Vasopressin was compared with non-active treatment or placebo in 4 randomised controlled trials [11][12][13][14], including only 157 patients (table 1). In two of these trials the intra-arterial route of administration was used [12,13]. Using meta-analysis, there was a significant heterogeneity in the evaluation of failure to control bleeding.…”

Untitled

“….Infusion of vasopressin directly into the superior mesenteric artery has failed to improve patient survival, though it may be more effective in controlling bleeding than peripheral infusions (20,21). Chojkier (22) found both routes to be equally useful, and as catheterization of the superior mesenteric artery is hazardous and seems to confer little or no benefit, it is now rarely used.…”

Pharmacological Treatment of Acute Variceal Bleeding

“…trials, only 4 trials compared the efficacy of vasopressin with a placebo [17,20,24,25] (table 1), and 2 of these The latter has become less popular as the operative mortality in cirrhotics remains high [8].…”

“…studies used an intra-arterial route of administration [24,25]. Using meta-analysis, there was a significant reThe only treatment that does not require the skills of a specialist, and is immediately available, is vasoactive duction in failure to control bleeding (pooled odds ratio 0.22, 95% CI 0.12-0.43), but no benefit in terms of mortaldrug therapy.…”