A Trial of Somatostatin With Endoscopic Variceal Ligation (EVL) in Control of Acute Variceal Bleeding
A Trial of Somatostatin With Endoscopic Variceal Ligation (EVL) in Control of Acute Variceal Bleeding
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.
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.