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 22 November 2017

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News

Is vapreotide an effective treatment for variceal bleeding in cirrhosis patients?

A team from France and Switzerland has assessed the effects of treating patients with vapreotide, a somatostatin analogue, begun before endoscopic treatment, in the control of variceal bleeding.

News image

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Their findings have been reported in this week's New England Journal of Medicine.

277 patients with cirrhosis, who were hospitalized for acute upper gastrointestinal bleeding, were included in the trial.

The patients were randomly assigned to receive vapreotide (a 50-µg intravenous bolus, followed by an infusion at a rate of 50 µg per hour for 5 days) or placebo within a mean of 2.3 hours after admission.

The patients received endoscopic treatment a mean of 2.6 hours after the infusion was begun. After the exclusion of 31 patients whose bleeding was not caused by portal hypertension, there were 98 patients in each group.

The team found that, at the time of endoscopy, active bleeding was evident in 31 per cent of patients in the vapreotide group, as compared with 46 per cent of patients in the placebo group. In 12 patients endoscopy was either impossible or showed portal hypertensive gastropathy.

Survival and control of bleeding achieved during 5-day infusion:

Vapreotide group - 66%
Placebo group- 50%

During the 5-day infusion, the primary objective - survival and control of bleeding - was achieved in 66 per cent of patients in the vapreotide group as compared with 50 per cent of patients in the placebo group.

The patients in the vapreotide group received significantly fewer blood transfusions (2.0 vs. 2.8 units). Overall mortality rates at 42 days were not significantly different in the two groups.

Researcher Paul Cales said on behalf of the group, "In patients with cirrhosis and variceal bleeding, the combination of vapreotide and endoscopic treatment is more effective than endoscopic treatment alone as a method of controlling acute bleeding."

"However, the use of combination therapy does not affect mortality rates at 42 days," he concluded.

N Engl J Med 2001; 344: 23-8
05 January 2001

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