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. 1997 Oct;41(4):526–533. doi: 10.1136/gut.41.4.526

A multicentre randomised trial comparing octreotide and injection sclerotherapy in the management and outcome of acute variceal haemorrhage

S Jenkins 1, R Shields 1, M Davies 1, E Elias 1, A Turnbull 1, M Bassendine 1, O James 1, J Iredale 1, S Vyas 1, M Arthur 1, A Kingsnorth 1, R Sutton 1
PMCID: PMC1891518  PMID: 9391254

Abstract

Background—Few studies have compared vasoactive drugs with endoscopic sclerotherapy in the control of acute variceal haemorrhage. Octreotide is widely used for this purpose, but its value remains undetermined. 
Aims—To compare octreotide with endoscopic sclerotherapy for acute variceal haemorrhage. 
Patients—Consecutive patients with acute variceal haemorrhage. 
Methods—Patients were randomised at endoscopy to receive either a 48 hour intravenous infusion of 50 µg/h octreotide (n=73), or emergency sclerotherapy (n=77). 
Results—Overall control of bleeding and mortality was 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 at endoscopy. 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 an overall trend towards an increased mortality in the octreotide group which 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 indicate that intravenous octreotide is as effective as injection sclerotherapy in the control of acute variceal bleeding, but further controlled trials are necessary to evaluate the safety of this treatment. 



Keywords: variceal haemorrhage; octreotide; injection sclerotherapy

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Figure 1 .

Figure 1

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: Kaplan-Meier plots for times to rebleeding after initiation of therapy in the sclerotherapy (INJ) and octreotide (OCT) groups. Time zero indicates the commencement of therapy. 


Figure 2 .

Figure 2

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: Kaplan-Meier plots for time to rebleeding after sclerotherapy (INJ/AB) or octreotide (OCT/AB) in patients with Child's A or B liver diseases and in patients with Child's C liver function in the sclerotherapy (INJ/C) and octreotide (OCT/C) groups are plotted separately. Time zero indicates commencement of therapy. 


Figure 3 .

Figure 3

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: Kaplan-Meier survival plots for patients randomised to receive injection sclerotherapy (INJ) or octreotide (OCT). Time zero indicates the commencement of therapy. 


Figure 4 .

Figure 4

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: Kaplan-Meier survival plots for patients with Child's A and B liver disease randomised to receive sclerotherapy (INJ/AB) or octreotide (OCT/AB). The survival of patients with severe liver disease (Child's C) in either the sclerotherapy (INJ/C) or octreotide (OCT/C) group was plotted separately. Time zero indicates the commencement of therapy. 


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