CHAPTER 3 SOMATOSTATIN IN VARICEAL BLEEDING

Early Administration of Vapreotide for Variceal Bleeding in Patients with Cirrhosis

Calès P, Masliah C, Bernard B, et al. NEJM. 2001;344(1):23–28

BACKGROUND

Mortality from a single episode of esophageal variceal bleeding ranges from 10% to 70% depending on the degree of underlying liver dysfunction.¹ It is critical to stop acute bleeding and to prevent rebleeding after sclerotherapy, but research results regarding the benefit of adding a somatostatin analog were mixed. One 1995 study showed that the combination of the somatostatin analog octreotide and sclerotherapy was more effective than sclerotherapy alone in the control of acute variceal bleeding, though overall mortality was not affected.² Prior to this study, patients were frequently treated with both somatostatin analogs and endoscopic therapy, although the overall benefit of somatostatin analogs and the need of early administration were unclear.

OBJECTIVES

To determine if the administration of vapreotide prior to endoscopy affected the control of variceal bleeding, the rate of early recurrence, or 42-day mortality.

METHODS

Double-blinded prospective randomized control trial at 22 medical centers between 1997 and 1998.

Patients

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