Endoscopic versus endoscopic plus octreotide treatment for acute variceal bleeding. Benefit according to severity at admission [Tratamiento endoscópico y combinado con octreotide en hemorragia por várices esofágicasbeneficio según la gravedad al ingreso]
Berreta J.,Servicio de Terapia Intensiva |
Kociak D.,Servicio de Terapia Intensiva |
Romero G.,Servicio de Hepatologia |
Balducci A.,Servicio de Terapia Intensiva |
And 2 more authors.
Acta Gastroenterologica Latinoamericana | Year: 2013
Vasoactive agents plus endoscopic treatment was recommended in esophageal variceal bleeding (EVB)However, the use according to severity on admission has been poorly evaluatedObjectivesTo evaluate the efficacy of endoscopic versus endoscopic plus octreotide treatment in patients with EVB according to severity on admissionMethodsBetween June 2001 and December 2011, 247 patients with EVB were treated using endoscopic or combined endoscopic plus octreotide treatmentPatients were analyzed according to the following cohorts: all patients, those with and without active bleeding, and by Child classesInitial hemostatic failure, inhospital rebleeding and in-hospital mortality were compared with both treatmentsResultsAll patients with combined treatment had less initial hemostatic failure (P = 0.0157) and rebleeding (P = 0.0011) when compared to endoscopic treatmentActive bleeding patients and Child C patients had a significant reduction of initial hemostatic failure when receiving combined treatment vs endoscopic treatment (P =0.0479 and P = 0.0222, respectively)Child C patients and patients without active bleeding significantly decreased rebleeding with combined treatment (P = 0.0139 and P = 0.0056, respectively)Global mortality was 17%, and did not differ between treatmentsNone patient in Child A diedConclusionsCombined endoscopic plus octreotide treatment in patients with EVB resulted in a reduction of initial hemostatic failure and rebleedingMoreover, the most relevant effect of combined treatment in decreasing initial hemostatic failure was seen in Child C and active bleeding patients, and for in-hospital rebleeding the same effect was seen in Child C and in patients without active bleedingMortality did not differ with both mentioned treatments.