Comparative Efficacy of Terlipressin and Octreotide along with Endoscopic Band Ligation in the Management of Esophageal Variceal Bleeding
Abstract
Abstract Views: 520
Esophageal variceal bleeding is a medical emergency that carries a high mortality rate despite appropriate management. Terlipressin and Octreotide are two common agents used as adjuvant agents in the management of variceal bleeding. The objective of this study is to compare the effectiveness of Terlipressin with Octreotide along with endoscopic band ligation in the management of esophageal variceal bleeding in cirrhotic patients. This randomized control study was carried out at the Department of General Medicine, Fatima Memorial Hospital, Lahore, for six months extending from February 2019 to July 2019. A total of 100 cirrhotic patients were selected /based on predetermined inclusion and exclusion criteria. The patients were randomly divided into two groups of equal strength. Hence, 50 patients were included in Group A and 50 patients were included in Group B along with banding. Group A received Terlipressin whereas Group B received Octreotide. The two groups were monitored for variceal bleeding for 72 hours. The mean age of the patients in Group A was 55.9±7.3 years and for the patients in Group B it was 56.8±7.4 years. In Group A, 36 (72.0%) male and 14 (28.0%) female patients were included. In Group B, there were 34 (68.0%) male and 16 (32.0%) female patients. In Group A, the treatment was effective for 46 (92.0%) patients and in Group B, 36 (72.0%) patients had an effective treatment. It is concluded from this study that Terlipressin is statistically more effective than Octerotide in terms of preventing esophageal variceal bleeding.
Copyright (c) The Authors
Downloads
References
Pinzani M, Rosselli M, Zuckermann M. Liver cirrhosis. Best Pract Res Clin Gastroenterol. 2011;25(2):281-90. https://doi.org/10.1016/j.bpg.2011.02.009
Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. The Lancet. 2014;383(9930):1749-61. https://doi.org/10.1016/S0140-6736(14)60121-5
Iwakiri Y, Groszmann RJ. Pathophysiology of portal hypertension. The Liver: Biology and Pathobiology. 6th ed. 2020:659-69. https://doi.org/10.1002/9781119436812.ch51
Nusrat S, Khan MS, Fazili J, Madhoun MF. Cirrhosis and its complications: evidence based treatment. World J Gastroenterol. 2014;20(18):5442-5460. doi:10.3748/wjg.v20.i18.5442
Azam, Z., Hamid S, Jafri W, et al. Short course adjuvant terlipressin in acute variceal bleeding: a randomized double blind dummy controlled trial. J hepatol. 2012 Apr 1;56(4):819-24. https://doi.org/10.1016/j.jhep.2011.11.019
D'Amico G, De Franchis R; Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology. 2003;38(3):599-612. https://doi.org/10.1053/jhep.2003.50385
Smith MM. Emergency: Variceal hemorrhage from esophageal varices associated with alcoholic liver disease. Am J Nurs. 2010;110(2):32-41.
Grace ND. Diagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 1997;92(7):1081-1091.
Aziz M, Floyd B, Esfandyari T. A Rare Case of Complete Esophageal Obstruction Following Esophageal Variceal Band Ligation (EVBL) for Esophageal Varices Performed by Esophagogastroduodenoscopy (EGD). Am J Case Rep. 2018;19:545-548. doi:10.12659/AJCR.908232
Lo GH, Chen WC, Wang HM, et al. Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices. Gut. 2009;58(9):1275-1280. http://dx.doi.org/10.1136/gut.2008.165910
Bruha R, Marecek Z, Spicak J, et al. Double-blind randomized, comparative multicenter study of the effect of terlipressin in the treatment of acute esophageal variceal and/or hypertensive gastropathy bleeding. Hepatogastroenterology. 2002;49(46):1161-1166.
Azam Z, Hamid S, Jafri W, et al. Short course adjuvant terlipressin in acute variceal bleeding: a randomized double blind dummy controlled trial. J Hepatol. 2012;56(4):819-824. https://doi.org/10.1016/j.jhep.2011.11.019
Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev. 2003;(1):CD002147. https://doi.org/10.1002/14651858.CD002147
Lebrec D. A discussion of how terlipressin limits mortality in cases of bleeding oesophageal varices. Eur J Gastroenterol Hepatol. 1998;10(7):549-552. doi:10.1097/00042737-199807000-00004
Abid S, Jafri W, Hamid S, et al. Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebo-controlled trial. Am J Gastroenterol. 2009;104(3):617-623. doi:10.1038/ajg.2008.147
Asad M, Alam MF. A comparison of Terlipressin and Octreotide for the control of esophageal variceal bleeding in patients of liver cirrhosis. J Clin Exp Hepatol. 2014;4: S86. https://doi.org/10.1016/j.jceh.2014.03.016
Ansari AI, Jalbani A, Shah AH, Gurbakhshani KM, Solangi GA, Shaikh A. Comparison of Terlipressin and Octreotide in the initial management of acute variceal bleeding. Med Channel. 2010. 16(3):385-389.
Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652-659. https://doi.org/10.1002/hep.20339
Chalasani N, Kahi C, Francois F, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol. 2003;98(3):653-659. https://doi.org/10.1016/S0002-9270(02)06016-1
de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005;43(1):167-176.
Dell'Era A, de Franchis R, Iannuzzi F. Acute variceal bleeding: pharmacological treatment and primary/secondary prophylaxis. Best Pract Res Clin Gastroenterol. 2008;22(2):279-294. https://doi.org/10.1016/j.bpg.2007.11.001
Zhou X, Tripathi D, Song T, et al. Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials. Med. 2018;97(48):e13437. doi:10.1097/MD.0000000000013437
Mottet C, Sieber CC, Nauer A, et al. Hemodynamic effects of the somatostatin analog lanreotide in humans: placebo-controlled, cross-over dose-ranging Echo-Doppler study. Hepatol. 1998;27(4):920-925. https://doi.org/10.1002/hep.510270405
Jenkins SA, Baxter JN, Corbett WA, Shields R. Effects of a somatostatin analogue SMS 201-995 on hepatic haemodynamics in the pig and on intravariceal pressure in man. Br J Surg. 1985;72(12):1009-1012. https://doi.org/10.1002/bjs.1800721225
D'Amico G, Traina M, Vizzini G, et al. Terlipressin or 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(2):206-212. https://doi.org/10.1016/S0168-8278(05)80059-5
Cho SB, Park KJ, Lee JS, 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(3):385-393.
Azeem AS, Khan AA, Muntaha ST, Tahir M, Shahzadi M, Khan ZA. Comparison of the efficacy of octreotide versus terlipressin in the prevention of early variceal rebleed after endoscopic banding and ligation. Pak Armed Forces Med J. 2018 ;68(3):471-74.
Fatima A, Chachar AZ, Ahmed SI, Qaisera S. Comparison of Terlipressin with Octreotide in Management of Acute Variceal Bleed in Patients with Liver Cirrhosis. J Rawalpindi Med College. 2017;21(3):191-6.
Copyright (c) 2020 Sadia Asif, Ayesha Shehbaz Khan, Sarmad Zahoor, Hafiz Mudabbar Mahboob, Uzma Malik, Rana Saif Ur Rehman
This work is licensed under a Creative Commons Attribution 4.0 International License.
BSR follows an open-access publishing policy and full text of all published articles is available free, immediately upon publication of an issue. The journal’s contents are published and distributed under the terms of the Creative Commons Attribution 4.0 International (CC-BY 4.0) license. Thus, the work submitted to the journal implies that it is original, unpublished work of the authors (neither published previously nor accepted/under consideration for publication elsewhere). On acceptance of a manuscript for publication, a corresponding author on the behalf of all co-authors of the manuscript will sign and submit a completed the Copyright and Author Consent Form.
