Gastroenterology

Gastroenterology

Volume 120, Issue 4, March 2001, Pages 946-954
Gastroenterology

Liver, Pancreas, and Biliary Tract
Octreotide for acute esophageal variceal bleeding: A meta-analysis☆,☆☆

https://doi.org/10.1053/gast.2001.22451Get rights and content

Abstract

Background & Aims: Studies of octreotide have not demonstrated a consistent benefit in efficacy or safety compared with conventional therapies. This study statistically pooled existing trials to evaluate the safety and efficacy of octreotide for esophageal variceal hemorrhage. Methods: We identified randomized trials of octreotide for variceal hemorrhage from computerized databases, scientific meeting abstracts, and the manufacturer of octreotide. Blinded reviewers abstracted the data, and a meta-analysis was performed. Results: Octreotide improved control of esophageal variceal hemorrhage compared with all alternative therapies combined (relative risk [RR], 0.63; 95% confidence interval [CI], 0.51–0.77); vasopressin/terlipressin (RR, 0.58; 95% CI, 0.42–0.81); or no additional intervention/placebo (among patients that received initial sclerotherapy/banding before randomization) (RR, 0.46; 95% CI, 0.32–0.67). Octreotide had comparable efficacy to immediate sclerotherapy for control of bleeding (RR, 0.94; 95% CI, 0.55–1.62), fewer major complications than vasopressin/terlipessin (RR, 0.31; 95% CI, 0.11–0.87), and a complication profile comparable to no intervention/placebo (RR, 1.06; 95% CI, 0.72–1.55). No specific alternative therapy demonstrated a mortality benefit. Conclusions: These results favor octreotide over vasopressin/terlipressin in the control of esophageal variceal bleeding and suggest it is a safe and effective adjunctive therapy after variceal obliteration techniques. Trials are needed to determine the optimal dose, route, and duration of octreotide treatment.

GASTROENTEROLOGY 2001;120:946-954

Section snippets

Data sources

A literature search of all English and non-English studies from January, 1985, to December, 1999, was performed using MEDLINE (publication type “clinical trial” with the key words “octreotide” or “somatostatin”), the Cochrane Library (keyword “octreotide”), and EMBASE (subject “gastrointestinal hemorrhage” and the keyword “octreotide” combined with clinical trial categories). Finally, abstracts and article bibliographies were manually searched, experts were consulted, and Novartis (octreotide's

Results

A total of 271 published articles on octreotide were identified with the MEDLINE search. The Cochrane Library search identified 381 published articles or abstracts and 1 Cochrane meta-analysis on somatostatin/octreotide for gastrointestinal hemorrhage; the Cochrane search found 2 unique abstracts and no unique published articles compared with the MEDLINE search. The EMBASE search identified 23 citations, without any unique publications. Manual searching identified 1 additional eligible

Discussion

The results of this meta-analysis suggest that, for patients with acute esophageal variceal hemorrhage, octreotide significantly improves sustained control of bleeding compared with all alternative therapies combined, vasopressin/terlipressin, or no intervention/placebo (among patients also receiving sclerotherapy/banding before treatment with octreotide). Octreotide has comparable efficacy to immediate sclerotherapy for sustained control of bleeding, fewer major complications than

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    ☆

    Supported in part by American Digestive Health Foundation Outcomes Research Training Award, National Institutes of Health Institutional Training Grant, and National Institutes of Health Mentored Clinical Scientist Award. Two of the authors (D.A.C., J.P.C.) have previously received unrestricted grants from Novartis Pharmaceutica (East Hanover, NJ), the manufacturer of octreotide.

    ☆☆

    Address requests for reprints to: Douglas A. Corley, M.D., M.P.H., S-357, UCSF, Box 0538, San Francisco, California 94143-0538. Fax: (415) 476-0659.

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    Copyright © 2001 American Gastroenterological Association. Published by Elsevier Inc. All rights reserved.