Background & Aims: Studies of octreotide have not demonstrated a consistent
benefit in efficacy or safety compared with conventional therapies. This s
tudy statistically pooled existing trials to evaluate the safety and effica
cy of octreotide for esophageal variceal hemorrhage. Methods: We 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.
Results: Octreotide improved control of esophageal variceal hemorrhage com
pared with all alternative therapies combined (relative risk [RR], 0.63; 95
% confidence interval [CI], 0.51-0.77); vasopressin/terlipressin (RR, 0.58;
95% CI, 0.42-0.81); or no additional intervention/placebo (among patients
that received initial sclerotherapy/banding before randomization) (RR, 0.46
; 95% CI, 0.32-0.67), Octreotide had comparable efficacy to immediate scler
otherapy for control of bleeding (RR, 0.94; 95% CI, 0.55-1.62), fewer major
complications than vasopressin/terlipessin (RR, 0.31; 95% CI, 0.11-0.87),
and a complication profile comparable to no intervention/placebo (RR, 1.06;
95% CI, 0.72-1.55), No specific alternative therapy demonstrated a mortali
ty benefit. Conclusions: These results favor octreotide over vasopressin/te
rlipressin in the control of esophageal variceal bleeding and suggest it is
a safe and effective adjunctive therapy after variceal obliteration techni
ques, Trials are needed to determine the optimal dose,route, and duration o
f octreotide treatment.