Acute Bleeding Esophageal Varices, Cirrhosis, Portal Hypertension
Conditions
Keywords
Variceal bleeding, Endoscopic therapy, Band ligation, Somatostatin, Vasoactive drugs, Octreotide
Brief summary
Background: Efficacy of endoscopic variceal sclerotherapy in achieving initial control of acute variceal bleeding and five-day haemostasis has been shown to significantly improve when vasoactive drug is added. However, there is limited data whether addition of somatostatin, to endoscopic variceal ligation (EVL) improves the efficacy of EVL. Aim: To compare EVL plus somatostatin versus EVL plus placebo in control of acute variceal bleeding. Patients and methods: Consecutive cirrhotic patients with acute variceal bleeding from esophageal varices were enrolled in the trial. After emergency EVL, patients were randomized to receive either somatostatin (250 mcg/hr) or placebo infusion. Primary endpoint was treatment failure within 5 days. Treatment failure was defined as fresh hematemesis ≥2 hour after start of therapy or death.
Interventions
DRUGSomatostatin
Emergency EVL plus Somatostatin (250 mcg/hr) infusion for 5 days
DRUGPlacebo
Emergency EVL plus placebo infusion for 5 days
Sponsors
Govind Ballabh Pant Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
12 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Clinical diagnosis of portal hypertension * Having hematemesis and/or melena within 24 hour prior to admission * Source of bleeding should be esophageal varices
Exclusion criteria
* Non-cirrhotic cause of portal hypertension * Age \<12 or \>75 years * Hepatic encephalopathy grade 3 or 4 * Renal failure with serum creatinine \>2 mg/dL * Any evidence of bleeding from additional source apart from esophageal varices (like gastric varices, portal hypertensive gastropathy, erosions or ulcers including variceal ulcers) * Patients already on vasoactive drugs like somatostatin or terlipressin during the current episode of bleeding * Patients already received EVL or EST elsewhere during the current episode of bleeding prior to presenting to our hospital * Patients with history of surgery for portal hypertension or TIPS * Concomitant severe cardio-pulmonary disease * Concomitant malignancy * HVPG not possible within 24 hrs of presentation * Patients refusing to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Treatment failure | 5 days | The primary endpoint was treatment failure, defined as the occurrence of any of the following within a period of 120 h (5 days) from the time of admission: (i) Fresh hematemesis ≥2 hr after EVL; or (ii) Death within 5 days. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| In-hospital mortality | During the same admission | Death during the same admission to the hospital |
| Transfusion requirement | During hospital stay | Amount of packed cell or FFP infusions received during the hospital stay |
| ICU stay in days | During the hospital stay | Number of dys the patient spent in ICU |
| Drug-related adverse effects | 5 days | Adverse effects due to somatostatin or placebo infusion |
Countries
India
Outcome results
None listed