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

Korean J Hepatol > Volume 12(3); 2006 > Article

The Korean Journal of Hepatology 2006;12(3): 385-393.

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

Sung Bum Cho , Kang Jin Park , Jung Soo Lee , Wan Sik Lee , Chang Hwan Park , Young Eun Joo , Hyun Soo Kim , Sung Kyu Choi , Jong Sun Rew , Sei Jong Kim

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea

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 μg/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.

KeyWords: Terlipressin; Octreotide; Hemostasis, endoscopic; Esophageal varix bleeding; Prevention & control