Somatostatin analogues for acute bleeding oesophageal varices

Abstract

Background: Somatostatin and its derivatives are often used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. The placebo controlled trials have shown varying results, however, and their power has been quite low. An updated systematic review of a previously published meta-analysis was therefore performed.

Objectives: To study whether somatostatin or analogues improve survival or reduce the number of blood transfusions in patients with suspected or verified acute or recently bleeding oesophageal varices.

Search strategy: MEDLINE and The Cochrane Library were searched in August 2001. Reference lists of articles and authors.

Selection criteria: All randomised trials comparing somatostatin or analogues with placebo or no treatment in patients suspected of acute bleeding from oesophageal varices.

Data collection and analysis: The effect variables extracted were: mortality, number of blood transfusions, number with balloon tamponade, number with initial haemostasis and number with rebleeding. Intention to treat analyses were conducted; a random effects analysis was preferred if there was significant heterogeneity between the trials (P < 0.10).

Main results: The meta-analysis comprised 12 trials and 1452 patients. The active drugs did not reduce mortality significantly (relative risk 0.93, 95% confidence interval (CI) 0.75 to 1.14). The number of transfusions was less with drugs, the difference between experimental and control therapy was 1.0 units of blood products (95% CI 0.6 to 1.5). Number of patients failing initial haemostasis was also reduced (relative risk 0.68, 95% CI 0.50 to 0.92). There were no significant differences in use of balloon tamponade (relative risk 0.68, 95% CI 0.37 to 1.24), or in number of patients with rebleeding (relative risk 0.61, 95% CI 0.35 to 1.09). It should be noted, however, that the trials were heterogeneous with respect to the secondary outcomes.

Reviewer's conclusions: The effect corresponded to one unit of blood saved per patient. It can be discussed whether this effect is worthwhile. The findings do not suggest a need for further placebo-controlled studies of somatostatin analogues in acute bleeding from oesophageal varices. On the other hand, the confidence interval for the effect on mortality was wide. Hence, a large placebo controlled trial is needed if one wishes to rule out the possibility that a worthwhile effect on mortality may have been overlooked.