Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices

Güven, Kadri; Özbakır, Ömer; YÜCESOY, Mehmet; Sungur, Murat; Gürsoy, Sebnem; GÜVEN, Muhammed; Başkol, Mevlüt; Keklik, Muzaffer

Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices

Mehmet YÜCESOY, (Erciyes Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Kayseri, Türkiye)

Mevlüt BAŞKOL, (Erciyes Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Kayseri, Türkiye)

Muzaffer KEKLİK, (Erciyes Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Kayseri, Türkiye)

Muhammed GÜVEN, (Erciyes Üniversitesi, Tıp Fakültesi, Yoğun Bakım Ünitesi, Kayseri, Türkiye)

Murat SUNGUR, (Erciyes Üniversitesi, Tıp Fakültesi, Yoğun Bakım Ünitesi, Kayseri, Türkiye)

Şebnem GÜRSOY, (Erciyes Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Kayseri, Türkiye)

Kadri GÜVEN, (Erciyes Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Kayseri, Türkiye)

Ömer ÖZBAKIR (Erciyes Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Kayseri, Türkiye)

Turkish Journal of Gastroenterology

0 0

Yıl: 2004 Cilt: 15 Sayı: 3 Sayfa Aralığı: 137 - 143 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices

Öz:

Amaç: Akut özofagus varis kanaması portal hipertansiyonun en ciddi komplikasyonudur. Siroz hastalarında kanamaya bağlı mortalite oldukça yüksektir. Olguların %30-50’si kanama sonrası 6 hafta içinde kaybedilir. Bu kötü seyir akut ve tekrarlayan kanamaları önlemek için bir çok yöntemin geliştirilmesini teşvik etmektedir. Bu çalışmanın amacı acil skleroterapi sonrası başlanan subkutan oktretid tedavisinin özofagus varis kanaması tekarını önlemedeki etkisini araştırmaktır. Yöntem: Olguların 34'ü standart tedavi grubunu oluştururken, 27 olgu da idame tedavisi grubunu oluşturmuştur. Tüm hastalara 50 mg iv bolus olarak verilen oktreotidi takiben, kanamayı izleyen 12-36 saat boyunca (endoskopik skleroterapi yapılana kadar) 50 mg/saat hızında oktreotid infüzyonu yapıldı. idame tedavisi grubuna skleroterapi sonrasında beş-yedi gün süreyle sekiz saatte bir 100 mg deri altı oktreotid verildi. Her iki gruba da ilk skleroterapiden sonraki beş-yedinci günlerde ikinci skleroterapiler yapıldı. Gruplardaki kanama süresi (gün), transfüzyon sayısı (ünite), tekrar kanama süresi (gün), hastanede kalış süresi (gün) ve üç hafta içindeki mortalite durumu kaydedildi. Bulgular: Standart tedavi grubunda 5 hastada, idame grubunda ise 1 hastada varis kanaması tekrarı gözlendi (3,7% vs. 26.5%; p<0.05). Transfüzyon gereksinimi ve hastanede kalış süresi her iki grupta benzerdi. Sonuç: Bu çalışma subkutan oktreotid idame tedavisinin varis kanaması tekrarını önlemede etkin bir ilaç olduğunu göstermiştir.

Anahtar Kelime: Özofageal ve gastrik varisler Skleroterapi Oktreotid

Konular: Cerrahi

Skleroterapi sonrası beş gün boyunca subkutan oktreotide tedavisinin özofagus varis kanaması tekrarı üzerine etkisi

Öz:

Background/aims: Acute variceal bleeding is the most severe consequence of portal hypertension. Mortality due to bleeding among cirrhotic patients is high; between 30 and 50% die within six weeks of the first bleeding episode. This dismal outcome has led to attempts both to stop acute bleeding and to prevent rebleeding. The aim of this study was to investigate the efficacy of subcutaneous octreotide treatment, administered after emergency sclerotherapy, in preventing rebleeding of esophageal varices Methods: After a bolus injection of 50 microgram octreotide, 34 patients, forming the standard therapy (ST) group, received octreotide infusion at a rate of 50 microgram/h until endoscopic sclerotherapy performed within 36 hours. The same procedure was applied to another 27 patients in the maintenance therapy (MT) group in which octreotide was given at 100 microgram/8h via subcutaneous (sc) route after sclerotherapy for five days. In both groups, sclerotherapy was repeated on the 5th-7th day. Patients were followed for three weeks for rebleeding. Results: Nine patients rebled in the ST group but only one patient bled in the MT group (3.7% vs. 26.5% vs. 3.7%; p<0.05). Transfusion requirement and duration of hospitalization period were similar in both groups. Conclusions: This study suggests that maintenance subcutaneous octreotide therapy is effective in controlling rebleeding episodes.

Anahtar Kelime: Esophageal and Gastric Varices Sclerotherapy Octreotide

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. D’Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Ballieres Clin Gastroenterol 1997; 11: 243-56.
2. D’Amico G, Franchis R, Touri V. End of century reappraisal of the 6-week outcome of upper gastrointestinal bleeding in cirrhosis: a prospective study. Gastroenterology 1999; 116: 1199A.
3. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 1981; 80: 800-9.
4. Christiensen E, Fauerholdt L, Schlichting P, et al. The Copenhagen Study Group for Liver Diseases. Aspects of the natural history of gastrointestinal bleeding in cirrhosis and the effect of prednisone. Gastroenterology 1981; 81: 944-52.
5. Sherlock S, Dooley J. The portal venous system and portal hypertension. In: Sherlock S, Dooley J (eds). Diseases of the Liver and Biliary System. London: Blackwell Scientific Publications (9th ed), 1993: 132-78.
6. Burroughs AK, McCormick PA, Hughes MD, et al. Randomized, double-blind, placebo-controlled trial of somatostatin for variceal bleeding. Emergency control and prevention of early variceal rebleeding. Gastroenterology 1990; 99: 1388-95.
7. Planas R, Quer JC, Boix J, et al. A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding. Hepatology 1994; 20: 370-5.
8. Shields R, Jenkins SA, Baxter JN, et al. A prospective randomized controlled trial comparing the efficacy of somatostatin with injection sclerotherapy in the control of bleeding oesophageal varices. J Hepatol 1992; 16: 128-37.
9. Jaramillo JL, Mata M, Mino G, et al. Somatostatin versus Sengstaken balloon tamponade for primary haemostasia of bleeding esophageal varices. A randomized pilot study. J Hepatol 1991; 12: 100-5.
10. Avgerinos A, Klonis C, Rekoumis G, et al. A prospective randomized trial comparing somatostatin, balloon tamponade and the combination of both methods in the management of acute variceal haemorrhage. J Hepatol 1991; 13: 78-83.
11. Sadowski DC. Use of octreotide in the acute management of bleeding esophageal varices. Can J Gastroenterol 1997; 11: 339-43.
12. Hwang SJ, Lin HC, Chang CF, et al. A randomized controlled trial comparing octreotide and vasopressin in the control of acute esophageal variceal bleeding. J Hepatol 1992; 16: 320-5.
13. McKee R. A study of octreotide in oesophageal varices. Digestion 1990; 45: 60-5.
14. Sung JJ, Chung SC, Lai CW, et al. Octreotide infusion or emergency sclerotherapy for variceal haemorrhage. Lancet 1993; 342: 637-41.
15. Levacher S, Letoumelin P, Pateron D, et al. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet 1995; 346: 865-8.
16. Fort E, Sautereay D, Silvain C, et al. A randomized trial of terlipressin plus nitroglycerin vs. balloon tamponade in the control of acute variceal hemorrhage. Hepatology 1990; 11: 678-81.
17. Silvain C, Carpentier S, Sautereau D, et al. Terlipressin plus transdermal nitroglycerin vs. octreotide in the control of acute bleeding from esophageal varices: a multicenter randomized trial. Hepatology 1993; 18: 61-5.
18. Hwang SH, Lin HC, Chang CF. A randomized controlled trial comparing octreotide and vasopressin in the control of acute esophageal variceal bleeding. J Hepatol 1992; 16: 320-5.
19. Avgerinos A, Nevens F, Raptis S, et al. Early administration of somatostatin and sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomized trial. Lancet 1997; 350: 1495-9.
20. Pedretti G, Elia G, Calzetti C, et al. Octreotide versus terlipressin in acute variceal hemorrhage in liver cirrhosis. Clin Investig 1994; 72: 653-9.
21. Levacher S, Letoumelin P, Pateron D, et al. Early admi nistration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet 1995; 346: 865-8.
22. Jenkins SA, Shields R, Davies M, et al. A multicentre ran domised trial comparing octreotide and injection sclerotherapy in the management and outcome of acute variceal haemorrhage. Gut 1997; 41: 526-33.
23. Sung JJ, Chung SC, Yung MY, et al. Prospective randomised study of effect of octreotide on rebleeding from oesophageal varices after endoscopic ligation. Lancet 1995; 346:1666-9.
24. Sivri B, Oksüzoğlu G, Bayraktar Y,et al. A prospective randomized trial from Turkey comparing octreotide versus injection sclerotherapy in acute variceal bleeding. Hepato-Gastroenterology 2000; 47: 168-73.
25. Jenkins SA, Baxter JN, Critchley M, et al. Randomised trial of octreotide for long-term management of cirrhosis after variceal haemorrhage. BMJ 1997; 315: 1338-41. 26. Ludwig D, Schadel S, Bruning A, et al. 48-hour hemodynamic effects of octreotide on postprandial splanchnic hyperemia in patients with liver cirrhosis and portal hypertension. Double-blind, placebo-controlled study. Dig Dis Sci 2000; 45: 1019-27.
27. Banares R, Albillos A, Rincon D, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002; 35: 609-15.
28. Besson I, Ingrand P, Person B, et al. Sclerotherapy with or without octreotide for acute variceal bleeding. N Engl J Med 1995; 333: 555-60.
29. Zuberi BF, Baloch Q. Comparison of endoscopic variceal sclerotherapy alone and in combination with octreotide in controlling acute variceal hemorrhage and early rebleeding in patients with low-risk cirrhosis. Am J Gastroenterol 2000; 95: 768-71.
30. D'Amico G, Politi F, Morabito A, et al. Octreotide compared with placebo in a treatment strategy for early rebleeding in cirrhosis. A double blind randomized pragmatic trial. Hepatology 1998; 28: 1206-14.

APA	YÜCESOY M, Başkol M, Keklik M, GÜVEN M, Sungur M, Gürsoy S, Güven K, Özbakır Ö (2004). Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. , 137 - 143.
Chicago	YÜCESOY Mehmet,Başkol Mevlüt,Keklik Muzaffer,GÜVEN Muhammed,Sungur Murat,Gürsoy Sebnem,Güven Kadri,Özbakır Ömer Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. (2004): 137 - 143.
MLA	YÜCESOY Mehmet,Başkol Mevlüt,Keklik Muzaffer,GÜVEN Muhammed,Sungur Murat,Gürsoy Sebnem,Güven Kadri,Özbakır Ömer Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. , 2004, ss.137 - 143.
AMA	YÜCESOY M,Başkol M,Keklik M,GÜVEN M,Sungur M,Gürsoy S,Güven K,Özbakır Ö Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. . 2004; 137 - 143.
Vancouver	YÜCESOY M,Başkol M,Keklik M,GÜVEN M,Sungur M,Gürsoy S,Güven K,Özbakır Ö Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. . 2004; 137 - 143.
IEEE	YÜCESOY M,Başkol M,Keklik M,GÜVEN M,Sungur M,Gürsoy S,Güven K,Özbakır Ö "Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices." , ss.137 - 143, 2004.
ISNAD	YÜCESOY, Mehmet vd. "Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices". (2004), 137-143.

APA	YÜCESOY M, Başkol M, Keklik M, GÜVEN M, Sungur M, Gürsoy S, Güven K, Özbakır Ö (2004). Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. Turkish Journal of Gastroenterology, 15(3), 137 - 143.
Chicago	YÜCESOY Mehmet,Başkol Mevlüt,Keklik Muzaffer,GÜVEN Muhammed,Sungur Murat,Gürsoy Sebnem,Güven Kadri,Özbakır Ömer Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. Turkish Journal of Gastroenterology 15, no.3 (2004): 137 - 143.
MLA	YÜCESOY Mehmet,Başkol Mevlüt,Keklik Muzaffer,GÜVEN Muhammed,Sungur Murat,Gürsoy Sebnem,Güven Kadri,Özbakır Ömer Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. Turkish Journal of Gastroenterology, vol.15, no.3, 2004, ss.137 - 143.
AMA	YÜCESOY M,Başkol M,Keklik M,GÜVEN M,Sungur M,Gürsoy S,Güven K,Özbakır Ö Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. Turkish Journal of Gastroenterology. 2004; 15(3): 137 - 143.
Vancouver	YÜCESOY M,Başkol M,Keklik M,GÜVEN M,Sungur M,Gürsoy S,Güven K,Özbakır Ö Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices. Turkish Journal of Gastroenterology. 2004; 15(3): 137 - 143.
IEEE	YÜCESOY M,Başkol M,Keklik M,GÜVEN M,Sungur M,Gürsoy S,Güven K,Özbakır Ö "Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices." Turkish Journal of Gastroenterology, 15, ss.137 - 143, 2004.
ISNAD	YÜCESOY, Mehmet vd. "Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices". Turkish Journal of Gastroenterology 15/3 (2004), 137-143.