A comparison of two different dosages of somatostatin combined with sclerotherapy for the treatment of acute esophageal variceal bleeding: a prospective randomized trial

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ABSTRACT

Background: the association of somatostatin (SMT) with endoscopictherapy in patients with cirrhosis and variceal bleedingsignificantly improves the control of the bleeding episode, and hemodynamicdata have shown that a dosage of 500 µg/h allows amore marked reduction of portal pressure versus the usual dosageof 250 µg/h.Aim: to assess if the 500 µg/h dosage is associated with animproved outcome.Methods: sixty-two patients with variceal bleeding were includedin the study. Patients were randomized to receive the usualdosage of SMT (group I 250 µg/h), or a double dosage (group II500 µg/h), together with emergency endoscopic sclerotherapy.Results: the control of the bleeding episode was similar inboth groups of patients. Early rebleeding was less frequent in patientsreceiving double vs. single dosage of SMT (p = 0.06). Whenconsidering patients with advanced liver disease (Child-Pugh B orC) early rebleeding was significantly less frequent in patients receivingthe 500 µg/h dose of SMT (39 vs. 13%, p = 0.03).Conclusions: the perfusion of higher doses of SMT (500µg/h) in association with emergency sclerotherapy in patientswith cirrhosis and esophageal hemorrhage significantly decreasesthe rate of early rebleeding in patients with more advanced stagesof liver disease