Vapreotide in variceal bleeding

[摘要] Background: In patients with cirrhosis, pharmacologic or endoscopic treatment may control variceal bleeding. However, the effects of early administration of a somatostatin analogue followed by endoscopic treatment are unknown. Methods: We studied the effects of treatment with vapreotide, a somastatin analogue, begun before endoscopic treatment in 227 patients with cirrhosis who were hospitalised for acute upper gastrointestinal bleeding. The patients were randomly assigned to receive vapreotide (a 50-mug intravenous bolus followed by an infusion at a rate of 50 mug per h for 5 days) or placebo within a mean (+/-SD) of 2.3 +/- 1.5 h after admission. All the patients received endoscopic treatment a mean of 2.6 +/- 3.3 h after the infusion was begun. After the exclusion by portal hypertension, there were 98 patients in each group. Results: At the time of endoscopy, active bleeding was evident in 28 of 91 patients in the vapreotide group (31%), as compared with 43 of 93 patients in the placebo group (46%) (P = 0.03). During the 5-day infusion, the primary objective - survival and control of bleeding - was achieved ion 65 of 98 patients in the vapreotide group (66%) as compared with 49% of 98 patients in the placebo group (50%) (P = 0.02). The patients in the vapreotide group received significantly fewer blood transfusions (2.0 +/- 2.2 versus 2.8 +/- 2.8 units, P = 0.04). Overall mortality rates at 42 days were not significantly different in the two groups. Conclusions: 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.

[发布日期] 2002-07-01