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

This is the authors' abstract. We don't add key points for this paper.

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 μg 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. Key messages The long term use of vasoactive drugs as adjuvant treatment after endoscopic sclerotherapy or ligation for acute variceal haemorrhage has been suggested to reduce the risk of variceal rebleeding This randomised trial found that the addition of long term octreotide to endoscopic treatment reduced the rate of recurrent variceal haemorrhage in patients with cirrhotic portal hypertension Octreotide also improved survival after acute variceal haemorrhage in such patients Long term administration of somatostatin analogues offers a promising treatment to prevent recurrent variceal haemorrhage