Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1977 Sep;186(3):369–376. doi: 10.1097/00000658-197709000-00015

Control of bleeding varices by vasopressin: a prospective randomized study.

W C Johnson, W C Widrich, J E Ansell, A H Robbins, D C Nabseth
PMCID: PMC1396353  PMID: 302111

Abstract

From July 1975 to November 1976 25 patients with bleeding esophagogastric varices documented by endoscopy who failed to respond to conservative medical treatment were transferred to the Surgical Service. These patients, who were mainly Child's Class "C" alcoholic cirrhotic patients, were treated with vasopressin infused continuously using a standardized dose into either a peripheral vein or the superior mesenteric artery (SMA) according to a predetermined randomization. No significant difference in efficacy for control of bleeding (average rate = 56%) related to route of administration was found. Because catheter-related complications in the SMA group were significantly greater, we concluded that the method of choice in vasopressin treatment of esophagogastric variceal bleeding is a continuous infusion by way of a peripheral vein.

Full text

PDF
373

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aronsen K. F., Nylander G. The mechanism of vasopressin hemostasis in bleeding esophageal varices. An angiographic study in the dog. Acta Chir Scand. 1966 May;131(5):443–453. [PubMed] [Google Scholar]
  2. Barr J. W., Lakin R. C., Rösch J. Similarity of arterial and intravenous vasopressin on portal and systemic hemodynamics. Gastroenterology. 1975 Jul;69(1):13–19. [PubMed] [Google Scholar]
  3. Bauer J. J., Kreel I., Kark A. E. The use of the Sengstaken-Blakemore tube for immediate control of bleeding esophageal varices. Ann Surg. 1974 Mar;179(3):273–277. doi: 10.1097/00000658-197403000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Berardi R. S. Vascular complications of superior mesenteric artery infusion with pitressin in treatment of bleeding esophageal varices. Am J Surg. 1974 Jun;127(6):757–761. doi: 10.1016/0002-9610(74)90366-3. [DOI] [PubMed] [Google Scholar]
  5. CONN H. O., DALESSIO D. J. Multiple infusions of posterior pituitary extract in the treatment of bleeding esophageal varices. Ann Intern Med. 1962 Nov;57:804–809. doi: 10.7326/0003-4819-57-5-804. [DOI] [PubMed] [Google Scholar]
  6. Clark G. A. A comparison of the effects of adrenaline and pituitrin on the portal circulation. J Physiol. 1928 Nov 9;66(3):274–280. doi: 10.1113/jphysiol.1928.sp002526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. EISEMAN B., SILEN W., TYLER P., EARLEY T. The portal hypotensive action of pituitrin. Surg Forum. 1960;10:286–291. [PubMed] [Google Scholar]
  8. Erwald R., Wiechel K. L., Strandell T. Effect of vasopressin on regional splanchnic blood flows in conscious man. Acta Chir Scand. 1976;142(1):36–42. [PubMed] [Google Scholar]
  9. Hanson K. M. Vascular response of intestine and liver to intravenous infusion of vasopressin. Am J Physiol. 1970 Sep;219(3):779–784. doi: 10.1152/ajplegacy.1970.219.3.779. [DOI] [PubMed] [Google Scholar]
  10. JOHNSON L. L., NELSON H. M., Jr, HARDESTY W. H., PESKIN G. W. Enteric arteriovenous anastomoses and their contribution to portal hemodynamics. Surg Forum. 1960;11:272–273. [PubMed] [Google Scholar]
  11. Johnson W. C., Widrich W. C. Efficacy of selective splanchnic arteriography and vasopressin perfusion in diagnosis and treatment of gastrointestinal hemorrhage. Am J Surg. 1976 Apr;131(4):481–489. doi: 10.1016/0002-9610(76)90161-6. [DOI] [PubMed] [Google Scholar]
  12. KEHNE J. H., HUGHES F. A., GOMPERTZ M. L. The use of surgical pituitrin in the control of esophageal varix bleeding; an experimental study and report of two cases. Surgery. 1956 Jun;39(6):917–925. [PubMed] [Google Scholar]
  13. Lunderquist A., Simert G., Tylén U., Vang J. Follow-up of patients with portal hypertension and esophageal varices treated with percutaneous obliteration of gastric coronary vein. Radiology. 1977 Jan;122(1):59–63. doi: 10.1148/122.1.59. [DOI] [PubMed] [Google Scholar]
  14. Millette B., Huet P. M., Lavoie P., Viallet A. Portal and systemic effects of selective infusion of vasopressin into the superior mesenteric artery in cirrhotic patients. Gastroenterology. 1975 Jul;69(1):6–12. [PubMed] [Google Scholar]
  15. Nusbaum M., Conn H. O. Arterial vasopressin infusions: science or seance? Gastroenterology. 1975 Jul;69(1):263–267. [PubMed] [Google Scholar]
  16. Nusbaum M., Younis M. T., Baum S., Blakemore W. S. Control of portal hypertension. Selective mesenteric arterial infusion of vasopressin. Arch Surg. 1974 Mar;108(3):342–347. doi: 10.1001/archsurg.1974.01350270072013. [DOI] [PubMed] [Google Scholar]
  17. Oliver G., Schäfer E. A. On the Physiological Action of Extracts of Pituitary Body and certain other Glandular Organs: Preliminary Communication. J Physiol. 1895 Jul 18;18(3):277–279. doi: 10.1113/jphysiol.1895.sp000565. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Orloff M. J., Chandler J. G., Charters A. C., 3rd, Condon J. K., Grambort D. E., Modafferi T. R., Levin S. E. Emergency portacaval shunt treatment for bleeding esophageal varices. Prospective study in unselected patients with alcoholic cirrhosis. Arch Surg. 1974 Mar;108(3):293–299. doi: 10.1001/archsurg.1974.01350270027006. [DOI] [PubMed] [Google Scholar]
  19. Roberts C., Maddison F. E. Partial mesenteric arterial occlusion with subsequent ischemic bowel damage due to pitressin infusion. AJR Am J Roentgenol. 1976 Apr;126(4):829–831. doi: 10.2214/ajr.126.4.829. [DOI] [PubMed] [Google Scholar]
  20. SCHWARTZ S. I., BALES H. W., EMERSON G. L., MAHONEY E. B. The use of intravenous pituitrin in treatment of bleeding esophageal varices. Surgery. 1959 Jan;45(1):72–80. [PubMed] [Google Scholar]
  21. Shepherd A. P., Mailman D., Burks T. F., Granger H. J. Effects of norepinephrine and sympathetic stimulation on extraction of oxygen and 86Rb in perfused canine small bowel. Circ Res. 1973 Aug;33(2):166–174. doi: 10.1161/01.res.33.2.166. [DOI] [PubMed] [Google Scholar]
  22. Sirinek K. R., Martin E. W., Jr, Thomford N. R. Simultaneous isoproterenol affords cardiodynamic advantages during vasopressin administration. J Surg Res. 1976 Apr;20(4):299–308. doi: 10.1016/0022-4804(76)90017-2. [DOI] [PubMed] [Google Scholar]
  23. TEXTER E. C., Jr, CHOU C. C., MERRILL S. L., LAURETA H. C., FROHLICH E. D. DIRECT EFFECTS OF VASOACTIVE AGENTS ON SEGMENTAL RESISTANCE OF THE MESENTERIC AND PORTAL CIRCULATION. STUDIES WITH 1-EPINEPHRINE, LEVARTERENOL, ANGIOTENSIN, VASOPRESSIN, ACETYLCHOLINE, METHACHOLINE, HISTAMINE, AND SEROTONIN. J Lab Clin Med. 1964 Oct;64:624–633. [PubMed] [Google Scholar]
  24. Takeuchi J., Kubo T., Yoshida H., Kitagawa T., Tone T. Hemodynamics in the dog liver after carbon tetrachloride injury. J Appl Physiol. 1972 Mar;32(3):320–324. doi: 10.1152/jappl.1972.32.3.320. [DOI] [PubMed] [Google Scholar]
  25. Thomford N. R., Sirinek K. R. Intravenous vasopressin in patients with portal hypertension: advantages of continuous infusion. J Surg Res. 1975 Feb;18(2):113–117. doi: 10.1016/0022-4804(75)90006-2. [DOI] [PubMed] [Google Scholar]
  26. Widrich W. C., Robbins A. H., Nabseth D. C., O'Hara E. T., Johnson W. C., Loughlin K. V. Portal hypertension changes following selective splenorenal shunt surgery. Evaluation by percutaneous transhepatic portal catheterization, venography, and cinefluorography. Radiology. 1976 Nov;121(2):295–302. doi: 10.1148/121.2.295. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES