Octreotide for acute esophageal variceal bleeding: A meta-analysis☆☆☆

Abstract 

Background & Aims: Studies of octreotide have not demonstrated a consistent benefit in efficacy or safety compared with conventional therapies. This study statistically pooled existing trials to evaluate the safety and efficacy 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 compared 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 sclerotherapy 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 mortality benefit. Conclusions: These results favor octreotide over vasopressin/terlipressin in the control of esophageal variceal bleeding and suggest it is a safe and effective adjunctive therapy after variceal obliteration techniques. Trials are needed to determine the optimal dose, route, and duration of octreotide treatment.

GASTROENTEROLOGY 2001;120:946-954

Abbreviations:  CI , confidence interval, NNS , number of unpublished negative studies needed to nullify significant results, NNT , number needed to treat, RR , relative risk