Octreotide for acute esophageal variceal bleeding: A meta-analysis☆☆☆
Received 2 December 1999; accepted 26 October 2000.
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.
*Division of Gastroenterology, University of California, San Francisco; *UCSF Gastroenterology Clinical, Outcomes, and Epidemiology Research Group; §Medical Service, San Francisco General Hospital; ‡Department of Epidemiology and Biostatistics, University of California, San Francisco; and ∥General Internal Medicine Section, Department of Veterans Affairs Medical Center, San Francisco, California
☆ Supported in part by American Digestive Health Foundation Outcomes Research Training Award, National Institutes of Health Institutional Training Grant, and National Institutes of Health Mentored Clinical Scientist Award. Two of the authors (D.A.C., J.P.C.) have previously received unrestricted grants from Novartis Pharmaceutica (East Hanover, NJ), the manufacturer of octreotide.
☆☆ Address requests for reprints to: Douglas A. Corley, M.D., M.P.H., S-357, UCSF, Box 0538, San Francisco, California 94143-0538. Fax: (415) 476-0659.
ABSTRACT