Sivri B, Oksuzoglu G, Bayraktar Y, Kayhan B
Department of Gastroenterology, Hacettepe University, Ankara, Turkey.
Hepatogastroenterology. 2000 Jan-Feb;47(31):168-73.
BACKGROUNDS/AIMS: Bleeding from gastroesophageal varices continues to be a life threatening complication of chronic liver diseases and portal hypertension. The purpose of this randomized prospective study is to compare the efficacy of octreotide administration and emergency injection sclerotherapy for the control of actively bleeding esophageal varices and prevention of early rebleeding in patients with cirrhosis.
A total of 66 episodes of endoscopically proven active variceal bleeding in 52 patients were included in this study. Following admission to the hospital, the patients were resuscitated with blood and plasma, and fiberoptic endoscopy was performed within 2 hours. Thirty-six bleeds in 28 patients and 30 bleeds in 24 patients were randomized to endoscopic variceal sclerotherapy (1% polidocanol) and to octreotide infusion (at 50 micrograms/h for 12 hours following the initial 50 micrograms i.v. bolus), respectively.
Bleeding was initially controlled within 6 hours in 75% of episodes by endoscopic variceal sclerotherapy and in 73.3 by octreotide infusion (P > 0.05). There were no significant differences between the 2 groups in early rebleeding (within 72 hours of randomization) (22% vs. 22.7%), blood transfusion (4.2 +/- 1.8 units vs. 4.8 +/- 2.9 units), or hospital mortality (3.6% vs. 3.3%). Treatment failed in 9 episodes (25%) in the sclerotherapy group and in 8 episodes (26.7%) in the octreotide group.
We consider that Octreotide would appear to be as effective as sclerotherapy in both the early control of variceal hemorrhage and in the prevention of early recurrent bleeding and should therefore be considered the treatment of choice in those centers where 24-hour endoscopy is not available. Furthermore, even in hospitals that do have a 24-hour endoscopy service there is good evidence that octreotide therapy should be commenced as soon as a patient enters hospital with a suspected variceal bleed to achieve rapid homeostasis. When initial hemostasis is achieved, elective endoscopic therapies can be undertaken with greater success.
背景/目的：胃食管静脉曲张出血仍然是慢性肝病和门静脉高压症危及生命的并发症。这项随机前瞻性研究的目的是比较奥曲肽给药与急诊注射硬化疗法在控制肝硬化患者活动性食管静脉曲张出血及预防早期再出血方面的疗效。
本研究纳入了52例经内镜证实有活动性静脉曲张出血的66例次患者。入院后，患者接受输血和血浆复苏，并在2小时内进行纤维内镜检查。28例患者的36次出血和24例患者的30次出血分别被随机分配至内镜下静脉曲张硬化疗法（1%聚多卡醇）组和奥曲肽输注组（初始静脉推注50微克后，以50微克/小时的速度输注12小时）。
内镜下静脉曲张硬化疗法组75%的出血事件和奥曲肽输注组73.3%的出血事件在6小时内实现了初始止血（P>0.05）。两组在早期再出血（随机分组后72小时内）（22%对22.7%）、输血（4.2±1.8单位对4.8±2.9单位）或医院死亡率（3.6%对3.3%）方面无显著差异。硬化疗法组9例次（25%）和奥曲肽组8例次（26.7%）治疗失败。
我们认为，奥曲肽在早期控制静脉曲张出血和预防早期再出血方面似乎与硬化疗法一样有效，因此在没有24小时内镜检查的中心应被视为首选治疗方法。此外，即使在有24小时内镜检查服务的医院，也有充分证据表明，一旦怀疑患者有静脉曲张出血入院，应立即开始奥曲肽治疗以实现快速内稳态。当实现初始止血后，择期内镜治疗可能会更成功。
