Randomized Prospective Trial Comparing a 48 Hour Infusion to a Five-day Infusion of Octerotide in Patients with Acute Variceal Bleeding

Abstract

Background

To compare the efficacy of a 48 hour infusion of octerotide with a five-day infusion to prevent rebleeding and mortality at one week and one month in patients who present with acute esophageal variceal bleeding.

Materials and Methods

Patients who presented to Emam Hospital of Ahwaz Jundishapur University of Medical Sciences that were diagnosed with acute variceal bleeding were commenced on octerotide (50 μg bolus) followed by a continuous infusion of octerotide at a rate of 50 μg/h. All patients underwent emergency endoscopy within eight hours of admission. Only patients diagnosed with bleeding due to esophageal varices that were treated with endoscopic variceal band ligation were randomized to the study. Patients in group A continued the octerotide infusion for 48 hours and those in group B continued octerotide for a total of five days. Rebleeding and mortality was defined according to standard recognized criteria.

Results

A total of 70 patients were randomized, of which 35 were assigned to group A and 35 to group B. Primary hemostasis was achieved in all patients. The mean age of patients in group A was 45.4 years and in group B, it was 46.3 years. There was no rebleeding within one week, however there were three patients who rebled in group A and 2 from group B within one month, which was not statistically significant (p=0.62). The overall effect was not significant between the two treatment groups. In terms of mortality, within one week the p value was 0.14, whereas it was 0.56 at one month .

Conclusion

As there is a significant difference in terms of cost, need for infusion pumps and duration of patient stay if octerotide is to be given for a duration of five days, our data suggests that octerotide can be given for 48 hours with no differences in terms of rebleeding and mortality.