Randomised trial of octreotide for long term management of cirrhosis after variceal haemorrhage

BMJ. 1997 Nov 22;315(7119):1338-41. doi: 10.1136/bmj.315.7119.1338.

Abstract

Objective: To assess the efficacy of long term octreotide as adjuvant treatment to programmed endoscopic sclerotherapy after acute variceal haemorrhage in cirrhotic portal hypertension.

Design: Randomised clinical trial.

Setting: University hospital.

Subjects: 32 patients with cirrhotic portal hypertension.

Interventions: Programmed injection sclerotherapy with subcutaneous octreotide 50 micrograms twice daily for 6 months, or programmed injection sclerotherapy alone.

Main outcome measures: Episodes of recurrent variceal bleeding and survival.

Results: Significantly fewer patients receiving combined octreotide and sclerotherapy had episodes of recurrent variceal bleeding compared with patients given sclerotherapy alone (1/16 v 7/16; P = 0.037, Fisher's exact test), and their survival was significantly improved (P < 0.02, log rank test); this improvement was maintained for 12 months after the end of the study. Combined treatment also resulted in a sustained decrease in portal pressure (median decrease -6.0 mm Hg, interquartile range -10 to -4.75 mm Hg, P = 0.0002) compared with sclerotherapy alone (median increase 1.5 mm Hg, interquartile range 0.25 to 3.25 mm Hg), as well as a significant improvement in liver function as assessed by plasma concentrations of bilirubin, albumin, and alanine aminotransferase and by hepatocyte metabolism of aminopyrine labelled with carbon-14.

Conclusion: Long term octreotide may be a valuable adjuvant to endoscopic sclerotherapy for acute variceal haemorrhage in cirrhotic portal hypertension.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Chemotherapy, Adjuvant
  • Female
  • Gastrointestinal Agents / adverse effects
  • Gastrointestinal Agents / therapeutic use*
  • Hemorrhage / complications*
  • Humans
  • Hypertension, Portal / complications*
  • Liver Cirrhosis / drug therapy*
  • Male
  • Middle Aged
  • Octreotide / adverse effects
  • Octreotide / therapeutic use*
  • Recurrence
  • Sclerotherapy
  • Survival Rate
  • Treatment Outcome
  • Varicose Veins / complications*

Substances

  • Gastrointestinal Agents
  • Octreotide