Comparison of the effects and complications of combined therapies using endoscopic variceal ligation with octreotide or terlipressin in the control of acute esophageal variceal bleeding

Kim, Se Hyung; Ham, Jung Ho; Park, Jin Woo; Lee, Suck Ho; Kim, Hong Joo; Kim, Hyun Jun; Chung, Il Kwun; Kim, Hong Soo; Park, Sang Heum; Kim, Sun Joo

Abstract

BACKGROUND: In patients with liver cirrhosis, acute esophageal variceal bleeding is a life-threatening event with high mortality and subsequent recurrent bleeding despite of endoscopic therapy. So the effect of vasoactive agents used in combination with endoscopic therapy has been studied. The aim of this study was to compare the effects and complications of octreotide or terlipressin with endoscopic variceal ligation in the management of acute esophageal variceal bleeding.
METHODS
From January, 1999 to February, 2001, 73 cirrhotic patients admitted to the Soonchunhyang University Chonan Hospital because of acute esophageal variceal bleeding were included in this study. The patients were randomized to receive either octreotide (37 patients) or terlipressin (36 patients) in combination with endoscopic variceal ligation.
RESULTS
Initial control of bleeding was achieved in 35 (94.6%) patients receiving octreotide and in 33 (91.7%) patients receiving terlipressin. In the octreotide group, three patients with two cases of early rebleeding and one case of late rebleeding had rebleeding events, but in the terlipressin group, two patients with only early rebleeding bled again after initial control of bleeding. Two cases of myocardial ischemia were observed in terlipressin group, but there were no serious complications in octreotide group.
CONCLUSION
This study suggests that both octreotide and terlipressin in combination with endoscopic therapy, are efficious in the initial control and the prevention of subsequent rebleeding. Octreotide showed a relatively lower risk of severe adverse reactions than terlipressin.