Korean J Hepatol.  2006 Sep;12(3):373-384.

A Prospective Study Comparing the Efficacy of Early Administration of Terlipressin and Somatostatin for the Control of Acute Variceal Bleeding in Patients with Cirrhosis

• Seo YS
• Um SH
• Hyun JJ
• Kim YH
• Park S
• Keum BR
• Kim YS
• Jeen YT
• Lee HS
• Chun HJ
• Lee SW
• Choi JH
• Kim CD
• Ryu HS

Abstract

BACKGROUND/AIMS: Terlipressin and somatostatin decrease portal venous pressure and they are used for the treatment of variceal bleeding. However, only a few studies have compared the efficacy of these drugs in combination with other procedures for hemostasis. Therefore, we performed a prospective study to compare the efficacy of terlipressin and somatostatin for controlling acute variceal bleeding when used in combination with other procedures for hemostasis. METHODS: A total of 98 patients, who presented with variceal bleeding from September 2003 to May 2005, were randomly divided into the somatostatin group or terlipressin group. We compared the 5-day failure rate (defined as failure to control bleeding, rebleeding or death within 5 days of admission) and the 6-week mortality. The prognostic factors for 5-day failure and 6-week mortality were also evaluated. RESULTS: There were no differences in baseline characteristics between the two groups. The overall 5-day failure rate and the cumulative 6-week mortality were 16.3% and 15.8%, respectively. The five-day failure rate and the cumulative 6-week mortality were not significantly different between the somatostatin and terlipressin groups. Hepatocellular carcinoma, the baseline serum creatinine level and endoscopic treatment for hemostasis were the significant predictors of 5-day failure; the baseline serum creatinine level was the predictor of 6-week mortality. CONCLUSIONS: Both somatostatin and terlipressin were effective and showed comparable efficacy for the control of the acute variceal bleeding in the setting of a combined therapeutic approach. The baseline serum creatinine level may be a significant predictor for patient failure at 5 days and the 6-week mortality.

Keyword

Liver cirrhosis; Variceal bleeding; Hemostasis; Terlipressin; Somatostatin

MeSH Terms

Acute Disease
Aged
Carcinoma, Hepatocellular/complications
Esophageal and Gastric Varices/complications/*drug therapy
Female
Gastrointestinal Hemorrhage/complications/*drug therapy
Hemorrhage/complications/drug therapy
Hemostasis, Endoscopic
Humans
Liver/*blood supply
Liver Cirrhosis/*complications
Liver Diseases/drug therapy
Liver Neoplasms/complications
Lysine Vasopressin/administration & dosage/*analogs & derivatives/therapeutic use
Male
Middle Aged
Multivariate Analysis
Somatostatin/administration & dosage/*therapeutic use
Varicose Veins/complications/drug therapy
Vasoconstrictor Agents/administration & dosage/*therapeutic use