Octreotide for acute esophageal variceal bleeding: A meta-analysis

Citation
Da. Corley et al., Octreotide for acute esophageal variceal bleeding: A meta-analysis, GASTROENTY, 120(4), 2001, pp. 946-954
Citations number
41
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology","da verificare
Journal title
GASTROENTEROLOGY
ISSN journal
0016-5085 → ACNP
Volume
120
Issue
4
Year of publication
2001
Pages
946 - 954
Database
ISI
SICI code
0016-5085(200103)120:4<946:OFAEVB>2.0.ZU;2-J
Abstract
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.