A team from San Francisco, California, USA, evaluated the safety and efficacy of octreotide for esophageal variceal hemorrhage.
The researchers 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 on the pooled studies.
Octreotide was found to improve the control of esophageal variceal hemorrhage compared with all alternative therapies combined. The relative risk (RR) for octreotide was 0.63.
For vasopressin/terlipressin and no additional intervention/placebo (among patients that received initial sclerotherapy/banding before randomization), RRs were 0.58 and 0.46, respectively.
Octreotide had comparable efficacy to immediate sclerotherapy for control of bleeding (RR, 0.94). In addition, octreotide had fewer major complications than vasopressin/terlipessin (RR, 0.31), and a complication profile comparable to no intervention/placebo (RR, 1.06).
No specific alternative therapy demonstrated a mortality benefit.
Douglas A. Corley, of the University of California, San Francosco, said, "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," he concluded.