Korean J Med.  2002 May;62(5):497-503.

A prospective randomized controlled clinical trial comparing the effects of somatostatin and vasopressin for control of acute variceal bleeding in patients with liver cirrhosis

Affiliations
  • 1Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea. leehy@hanbat.chungnam.ac.kr
  • 2Department of Internal Medicine, Youngnam University College of Medicine, Daegu, Korea.

Abstract

BACKGROUND: Acute variceal bleeding is one of serious complications of liver cirrhosis that has an attendant mortality of approximately 60% during two years and a variety of treatments like balloon tamponade, sclerotherapy and vasoactive drugs have been used. The aim of the present trial was to compare the effectiveness and complications of somatostatin and vasopressin in the treatment of acute variceal bleeding.
METHODS
Fourty-three cirrhotic patients with endoscopically proven acute variceal bleeding were included. Both drugs were given as continuous intravenous infusions for 48 hour. Twenty patients received somatostatin (250 mcg per hour after a bolus of 50 mcg) and twenty-three recieved vasopressin (0.4 units per min).
RESULTS
There was no significant difference between two groups in relation to age, sex and etiology of cirrhosis, Child-Pugh classification, characteristics of bleeding episode, laboratory findings before randomization and units of transfused blood during therapy. Rebleeding within 6 hour after beginning of therapy, that is failure of initial control of bleeding, was observed in 3 (13.0%)patients receiving vasopressin and in 1 (5.0%) of those treated with somatostatin (p>0.05). Five patients (25.0%) in the somatostatin group and 5 (21.7%) in the vasopressin group rebled during 5 days after initial therapy (p>0.05). The meaningful complications related with vasopressin were observed in 5 patients (chest pain or abdominal pain requiring nitroglycerin) but serious complications of somatostatin were not found. Mortalities during hospitalization were similar in both treatment groups. Two of the vasopressin group and one of the somatostatin group died because of the uncontrolled rebleeding and one of the vasopressin group died due to hepatic failure.
CONCLUSION
This study shows that the effectiveness of somatostatin and vasopressin was not different but somatostatin had a lower risk of the complication than vasopressin.

Keyword

Varix; Bleeding; Somatostatin; Vasopressin

MeSH Terms

Abdominal Pain
Balloon Occlusion
Classification
Esophageal and Gastric Varices*
Fibrosis
Hemorrhage
Hospitalization
Humans
Infusions, Intravenous
Liver Cirrhosis*
Liver Failure
Liver*
Mortality
Prospective Studies*
Random Allocation
Sclerotherapy
Somatostatin*
Varicose Veins
Vasopressins*
Somatostatin
Vasopressins
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