Korean J Hepatol.  2006 Sep;12(3):385-393.

Comparison of Terlipressin and Octreotide with Variceal Ligation for Controlling Acute Esophageal Variceal Bleeding: a Randomized Prospective Study

• Cho SB
• Park KJ
• Lee JS
• Lee WS
• Park CH
• Joo YE
• Kim HS
• Choi SK
• Rew JS
• Kim SJ

Abstract

BACKGROUND/AIMS: Terlipressin and octreotide had been used to control acute variceal bleeding and to prevent early rebleeding after endoscopic hemostasis. We compared the efficacy and safety of terlipressin and octreotide combined with endoscopic variceal ligation (EVL) for the treatment of acute esophageal variceal bleeding and we evaluated their clinical significance as related to rebleeding. METHODS: The eighty eight cirrhotic patients were randomized to the terlipressin group (n=43; 2 mg i.v. initially and 1 mg i.v. at every 4 hours for 3 days) or the octreotide group (n=45; continuous infusion of 25 microgram/h for 5 days) combined with EVL for the treatment of acute esophageal variceal bleeding. RESULTS: The initial hemostasis rates were 98% (42/43 cases) in the terlipressin group and 96% (43/45 cases) in the octreotide group. The 5-day and 42-day rebleeding rates were 12% (5/43 cases) and 28% (12/43 cases), respectively, in the terlipressin group and 9% (4/45 cases) and 24% (11/45 cases), respectively, in the octreotide group. No significant difference was demonstrated between the terlipressin and octreotide groups. The mortality at 42 days was similar in both group, but a high mortality rate (48%) was shown to be related to 42-day rebleeding. The risk factors related to 42-day rebleeding were Child-Pugh class C (aOR=30.2, 95% CI=7.7-117.9), ascites above grade II (aOR=6.6, 95% CI=2.2-19.2) and advanced hepatocellular carcinoma (aOR=4.6, 95% CI=1.1-18.9). CONCLUSIONS: Comparing terlipressin and octreotide combined with EVL showed them to be equally safe and effective therapeutic agents in patients with acute esophageal variceal bleeding. The high risk factors related to early rebleeding were poor liver function and advanced hepatocellular carcinoma.

Keyword

Terlipressin; Octreotide; Hemostasis, endoscopic; Esophageal varix bleeding; Prevention and control

MeSH Terms

Acute Disease
Aged
Esophageal and Gastric Varices/drug therapy/surgery/*therapy
Female
Gastrointestinal Hemorrhage/drug therapy/surgery/*therapy
Humans
Liver Cirrhosis/drug therapy/surgery/*therapy
Lysine Vasopressin/*analogs & derivatives/therapeutic use
Male
Middle Aged
Octreotide/*therapeutic use
Vasoconstrictor Agents/*therapeutic use