A multicentre randomised trial comparing octreotide and injectionsclerotherapy in the management and outcome of acute varicealhaemorrhage

Background—Few studies have compared vasoactivedrugs with endoscopic sclerotherapy in the control of acute varicealhaemorrhage. Octreotide is widely used for this purpose, but its valueremains undetermined.
Aims—To compare octreotide with endoscopicsclerotherapy for acute variceal haemorrhage.
Patients—Consecutive patients with acute variceal haemorrhage.
Methods—Patients were randomised at endoscopy toreceive either a 48 hour intravenous infusion of 50 µg/h octreotide(n=73), or emergency sclerotherapy (n=77).
Results—Overall control of bleeding and mortalitywas not significantly different between octreotide (85%, 62 patients)and sclerotherapy (82%, 63 patients) over the 48 hour trial period (relative risk of rebleeding 0.83; 95% confidence interval (CI) 0.38 to 1.82), irrespective of Child's grading or active bleeding atendoscopy. One major complication was observed in the sclerotherapy group (aspiration) and two in the octreotide group (pulmonary oedema,severe paralytic ileus). During 60 days of follow up there was anoverall trend towards an increased mortality in the octreotide groupwhich was not statistically significant (relative risk of dying at 60 days 1.91, 95% CI 0.97 to 3.78, p=0.06).
Conclusions—The results of this study indicatethat intravenous octreotide is as effective as injection sclerotherapyin the control of acute variceal bleeding, but further controlledtrials are necessary to evaluate the safety of this treatment.

Keywords:variceal haemorrhage; octreotide; injectionsclerotherapy