Skip to main content
SpringerLink
Log in

Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding: a systematic review and meta-analysis

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Purpose

Our purpose was to conduct a meta-analysis to compare the effectiveness of vasopressin/terlipressin and somatostatin/octreotide on variceal re-bleeding within and after 5 days of initial control bleeding.

Methods

A search was conducted of PubMed, the Cochrane database, and Google Scholar until June 31, 2014 using combinations of the search terms: esophageal varices, variceal re-bleeding, recurrent variceal hemorrhage, early re-bleeding, vasopressin, somatostatin, terlipressin, octreotide. Inclusion criteria were: (1) randomized controlled trials, (2) patients with esophageal or esophageal and gastric varices confirmed by endoscopy, (3) re-bleeding control was evaluated, (4) treatment with somatostatin/vasopressin. Outcome measures were the re-bleeding rates within 5 days (≤5 days) or after 5 days (>5 days) after initial treatment.

Results

Six studies were included in the analysis. Five studies had complete data of re-bleeding rate within 5 days after initial treatment, and the combined odds ratio (OR) of 0.87 [95 % confidence interval (CI) 0.51, 1.50] indicated that there was no difference in the re-bleeding rate between patients treated with vasopressin/terlipressin or somatostatin/octreotide. Two studies had complete data of the re-bleeding rate 5 days after initial treatment, and the combined OR of 1.12 (95 % CI 0.64, 1.95) indicated there was no difference in the re-bleeding rate between patients who were treated with vasopressin/terlipressin or somatostatin/octreotide.

Conclusion

There is no difference between vasopressin/terlipressin and somatostatin/octreotide in prevention of re-bleeding after the initial treatment of bleeding esophageal varices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology. Gut 2000;46(Suppl 3–4):III1–III15

    PubMed Central  PubMed  Google Scholar 

  2. D’Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Ballieres Clin Gastroenterol 1997;11:243–256

    Article  Google Scholar 

  3. Abraldes JG, Villanueva C, Bañares R, Aracil C, Catalina MV, Garcia-Pagán JC, et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol 2008;48:229–236

    Article  PubMed  Google Scholar 

  4. Augustin S, Altamirano J, González A, Dot J, Abu-Suboh M, Armengol JR, et al. Effectiveness of combined pharmacologic and ligation therapy in high-risk patients with acute esophageal variceal bleeding. Am J Gastroenterol 2011;106:1787–1795

    Article  CAS  PubMed  Google Scholar 

  5. Villanueva C, Piqueras M, Aracil C, Gómez C, López-Balaguer JM, Gonzalez B, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol 2006;45:560–567

    Article  PubMed  Google Scholar 

  6. Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010;362:823–832

    Article  CAS  PubMed  Google Scholar 

  7. De Franchis R. Baveno V consensus faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010;53:762–768

    Article  PubMed  Google Scholar 

  8. Rockey DC. Pharmacologic therapy for gastrointestinal bleeding due to portal hypertension and esophageal varices. Curr Gastroenterol Rep 2006;8:7–13

    Article  PubMed  Google Scholar 

  9. de Franchis R. Somatostatin, somatostatin analogues and other vasoactive drugs in the treatment of bleeding oesophageal varices. Dig Liver Dis 2004;36(Suppl 1):S93–S100

    Article  PubMed  Google Scholar 

  10. Fogel MR, Knauer CM, Andres LL, Mahal AS, Stein DE, Kemeny MJ, et al. Continuous intravenous vasopressin in active upper gastrointestinal bleeding. Ann Intern Med 1982;96:565–569

    Article  CAS  PubMed  Google Scholar 

  11. Mallory A, Schaefer JW, Cohen JR, Holt SA, Norton LW. Selective intra-arterial vasopressin in fusion for upper gastrointestinal tract hemorrhage: a controlled trial. Arch Surg 1980;115:30–32

    Article  CAS  PubMed  Google Scholar 

  12. Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev 2003 1:CD002147

  13. Escorsell A, Ruiz del Arbol L, Planas R, Albillos A, Bañares R, Calès P, et al. Multicenter randomized controlled trial of terlipressin versus sclerotherapy in the treatment of acute variceal bleeding: the TEST study. Hepatology 2000;32:471–476

    Article  CAS  PubMed  Google Scholar 

  14. Escorsell A, Bandi JC, Moitinho E, Feu F, García-Pagan JC, Bosch J, et al. Time profile of the haemodynamic effects of terlipressin in portal hypertension. J Hepatol 1997;26:621–627

    Article  CAS  PubMed  Google Scholar 

  15. Chiu KW, Sheen IS, Liaw YF. A controlled study of glypressin versus vasopressin in the control of bleeding from oesophageal varices. J Gastroenterol Hepatol 1990;5:549–553

    Article  CAS  PubMed  Google Scholar 

  16. Freeman JG, Cobden I, Record CO. Placebo-controlled trial of terlipressin (glypressin) in the management of acute variceal bleeding. J Clin Gastroenterol 1989;11:58–60

    Article  CAS  PubMed  Google Scholar 

  17. D’Amico G, Traina M, Vizzini G, Tinè F, Politi F, Montalbano L, et al. Terlipressinor vasopressin plus transdermal nitroglycerin in a treatment strategy for digestive bleeding in cirrhosis. A randomized clinical trial. Liver Study Group of V. Cervello Hospital. J Hepatol 1994;20:206–212

    Article  PubMed  Google Scholar 

  18. Silvain C, Carpentier S, Sautereau D, Czernichow B, Métreau JM, Fort E, et al. Terlipressin plus transdermal nitroglycerin vs. octreotide in the control of acute bleeding from esophageal varices: a multicenter randomized trial. Hepatology 1993;18:61–65

    CAS  PubMed  Google Scholar 

  19. Walker S, Kreichgauer HP, Bode JC. Terlipressin (glypressin) versus somatostatin in the treatment of bleeding esophageal varices—final report of a placebo-controlled, double-blind study. Z Gastroenterol 1996;34:692–698

    CAS  PubMed  Google Scholar 

  20. García-Pagán JC, Reverter E, Abraldes JG, Bosch J. Acute variceal bleeding. Semin Respir Crit Care Med 2012;33:46–54

    Article  PubMed  Google Scholar 

  21. Abraldes JG, Bosch J. Somatostatin and analogues in portal hypertension. Hepatology 2002;35:1305–1312

    Article  CAS  PubMed  Google Scholar 

  22. Qi X, Liu L, Bai M, Chen H, Wang J, Yang Z, et al. Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: a meta-analysis. J Gastroenterol Hepatol 2014;29:688–696

    Article  PubMed  Google Scholar 

  23. Zheng M, Chen Y, Bai J, Zeng Q, You J, Jin R, et al. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients: meta-analysis update. J Clin Gastroenterol 2008;42:507–516

    Article  PubMed  Google Scholar 

  24. Thiele M, Krag A, Rohde U, Gluud LL. Meta-analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices. Aliment Pharmacol Ther 2012;35:1155–1165

    Article  CAS  PubMed  Google Scholar 

  25. Funakoshi N, Ségalas-Largey F, Duny Y, Oberti F, Valats JC, Bismuth M, et al. Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: a meta-analysis. World J Gastroenterol 2010;16:5982–5992

    PubMed Central  PubMed  Google Scholar 

  26. Wells M, Chande N, Adams P, Beaton M, Levstik M, Boyce E, et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012;35:1267–1278

    Article  CAS  PubMed  Google Scholar 

  27. Corley DA, Cello JP, Adkisson W, Ko WF, Kerlikowske K. Octreotide for acute esophageal variceal bleeding: a meta-analysis. Gastroenterology 2001;120:946–954

    Article  CAS  PubMed  Google Scholar 

  28. Imperiale TF, Teran JC, McCullough AJ. A meta-analysis of somatostatin versus vasopressin in the management of acute esophageal variceal hemorrhage. Gastroenterology 1995;109:1289–1294

    Article  CAS  PubMed  Google Scholar 

  29. Clinical Practice Guideline “Management of Acute Variceal Bleeding” May 2007. Ministry of Health, Malaysia

  30. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998;51:1235–1241

    Article  CAS  PubMed  Google Scholar 

  31. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ 2000;320:1574–1577

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Seo YS, Park SY, Kim MY, Kim JH, Park JY, Yim HJ, et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology 2014;60(3):954-63. doi:10.1002/hep.27006

  33. Adarsh CK, Prasanna KS, Devarbhavi H, Karanth D, Patil M, Balaraju G, et al. Comparative study of terlipressin, somatostatin, and octreotide in acute esophageal variceal bleed: a prospective randomised study. Hepatology 2011;54:459A

    Google Scholar 

  34. Cho SB, Park KJ, Lee JS, Lee WS, Park CH, Joo YE, et al. Comparison of terlipressin and octreotide with variceal ligation for controlling acute esophageal variceal bleeding—a randomized prospective study. Korean J Hepatol 2006;12:385–393

    PubMed  Google Scholar 

  35. Seo YS, Um SH, Hyun JJ, Kim YH, Park S, Keum BR, et al. A prospective study comparing the efficacy of early administration of terlipressin and somatostatin for the control of acute variceal bleeding in patients with cirrhosis. Korean J Hepatol 2006;12:373–384

    PubMed  Google Scholar 

  36. Lee HY, Lee HJ, Lee SM, Kim JH, Kweon SW, Lee BS, et al. A prospective randomized controlled clinical trial comparing the effects of somatostatin and vasopressin for control of acute variceal bleeding in the patients with liver cirrhosis. Korean J Intern Med 2003;18:161–166

    CAS  PubMed  Google Scholar 

  37. Feu F, Ruiz del Arbol L, Bañares R, Planas R, Bosch J. Double-blind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage. Variceal Bleeding Study Group. Gastroenterology 1996;111:1291–1299

    Article  CAS  PubMed  Google Scholar 

  38. Saari A, Klvilaakso E, Inberg M, Pääkkönen M, Lahtinen J, Höckerstedt K, et al. Comparison of somatostatin and vasopressin in bleeding esophageal varices. Am J Gastroenterol 1990;85:804–807

    CAS  PubMed  Google Scholar 

  39. Walker S, Kreichgauer HP, Bode JC. Terlipressin vs. somatostatin in bleeding esophageal varices: a controlled, double-blind study. Hepatology 1992;15:1023–1030

    Article  CAS  PubMed  Google Scholar 

  40. Gøtzsche PC, Hróbjartsson A. Somatostatin analogues for acute bleeding oesophageal varices. Cochrane Database Syst Rev 2008:CD000193

  41. McCormick PA, O’Keefe C. Improving prognosis following a first variceal haemorrhage over four decades. Gut 2001;49:682–685

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Krige JE, Bornman PC, Shaw JM, Apostolou C. Complications of endoscopic variceal therapy. S Afr J Surg 2005;43:177–188

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Specialized Research Fund for the Doctoral Program of Higher Education of China (20120142120048) and Nature Science Foundation of Hubei Province (2012FFB02308).

Compliance with ethical requirements and Conflict of interest

This analysis has complied with all the ethical requirements with Tongji Medical College and Science and Technology of Huazhong University. Chao Wang, Juan Han, Liang Xiao, Chang-e Jin, Dong-jian Li, and Zhen Yang declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of General Surgery, Tongji Hospital, Tongji Medical College, Science and Technology of Huazhong University, No. 1095 Liberation Avenue, Wuhan, 430030, China

    Chao Wang, Dong-jian Li & Zhen Yang

  2. Department of Biliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Science and Technology of Huazhong University, No. 1095 Liberation Avenue, Wuhan, 430030, China

    Juan Han

  3. Department of General Surgery, The Second People’s Hospital of Shenzhen, No. 3002 Sungang West Road, Shenzhen, 518035, China

    Liang Xiao

  4. Department of Respiration Medicine, Shenzhen People’s Hospital, No. 1017 North Road of East Gate, Shenzhen, 518020, China

    Chang-e Jin

Authors
  1. Chao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liang Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chang-e Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong-jian Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhen Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chao Wang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, C., Han, J., Xiao, L. et al. Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding: a systematic review and meta-analysis. Hepatol Int 9, 120–129 (2015). https://doi.org/10.1007/s12072-014-9594-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-014-9594-9

Keywords

Search

Navigation