Acute Variceal Bleeding: Somatostatin or Sclerotherapy?

Shields, R., Jenkins, S. A., Baxter, J. N., Kingsnorth, A. N., Ellenbogen, S. A., Makin, C.A., Gilmore, I., Morris, A. I., Ashby, D. and West, C. R. (1992) A prospective randomised controlled trial comparing the efficacy of somatostatin with injection sclerotherapy in the control of bleeding oesophageal varices. Journal of Hepatology 16, 128-137. Since previous reports have suggested that somatostatin may be of value in the control of acute variceal haemorrhage, we compared its efficacy with that of injection sclerotherapy in a randomised controlled clinical trial. Eighty consecutive patients with endoscopicallyproven severe variceai bleeding were randomised to injection sclerotherapy (n--41) or somatostatin (n-39) given as a continuous infusion of 250 pg/h for 5 days plus daily bolus administration of 250 pg. The efficacy of injection sclerotherapy and somatostatin infusion in controlling haemorrhage and preventing rebleeding (censored at 5days), mortality (censored at 28 days) and complications was compared. The aetiology of the portal hypertension and transfusion requirements was similar between the two groups, but there were more patients with severe liver disease (Child’s C) in the somatostatin group. 70 HPB INTERNATIONAL There was no significant difference between the two treatments in the initial (p 1.0) or overall control of bleeding (p--0.58). Furthermore, somatostatin was as effective as injection sclerotherapy in cotrolling bleeding in patients with severe liver disease or in those actively bleeding at the time of their endoscopy. The relative risk of rebleeding whilst receiving somatostatin compared to injection sclerotherapy was 1.39 [95% Confidence Interval (CI) 3.73; 0.52], but this was reduced to 0.98 (95% CI 0.37; 2.67) when readjusted for Child’s grading, the only prognostic factor shown to be of significance. Mortality was not significantly different between the two groups of patients (p 0.31). The relative risk of dying whilst receiving somatostatin compared to injection sclerotherapy was 1.6 (95% CI 3.93; 0.66) but was reduced to 1.03 (95% CI 0.47; 2.47) when adjusted for Child’s grading, the only significant prognostic factor. Complications in the somatostatin group were minor and less frequent than after injection sclerotherapy. The results of this study indicate that somatostatin is a safe treatment, which is as effective as endoscopic injection sclerotherapy for acute variceal bleeding.