Comparison of 2 Days Versus 5 Days of Octreotide After Endoscopic Therapy in Preventing Early Esophageal Varices Rebleed : A Randomized Controlled Study
- Registration Number
- NCT05199038
- Lead Sponsor
- Tanta University
- Brief Summary
The aim of this study is to compare the efficacy of 2-days versus 5-days octreotide infusion after endoscopic therapy in preventing early esophageal varices rebleed in patients with cirrhosis.
- Detailed Description
Variceal hemorrhage, causative of 70% of all upper gastrointestinal (GIT) bleeding events in patients with portal hypertension, remains one of the most severe and immediate life-threatening complications in patients with cirrhosis and constitutes the second most frequent decompensating event after ascites .
Gastro-esophageal varices are identified in about 30% of patients with compensated cirrhosis and 60% of patients with de-compensated cirrhosis . Esophageal variceal bleeding (EVB) occurs in 10-20% of cirrhotic patients per year and each bleeding episode can be associated with in-hospital mortality .
Mortality during the first episode is estimated to 15-20% but is higher in severe patients (Child Pugh C), at around 30%, whereas it is very low in patients with compensated cirrhosis (Child Pugh A) .The main predictors of bleeding in clinical practice are: large versus small varices, red wale marks, Child Pugh C versus Child Pugh A-B .
Treatment of variceal bleeding should be started as soon as bleeding is clinically confirmed, regardless the lack of confirmation by upper endoscopy . Initial therapy should be directed at restoring blood volume. Vasoactive drug therapy and antibiotic prophylaxis should be initiated as soon as AVB is suspected. Goals of therapy in AVB include the control of bleeding, as well as the prevention of early recurrence and the prevention of six-week mortality .
Starting vasoactive drugs before endoscopy decreases the incidence of active bleeding during endoscopy and facilitates endoscopic therapy, improving the control of bleeding, and potentially survival. Terlipressin, somatostatin or octreotide are accepted drugs with proven efficacy .
Once AVB is confirmed, vasoactive drug therapy should be administered for five days to avoid early rebleeding. Shorter administration of vasoactive drugs (48-72 h) can be considered in less severe episodes although more data are required .The optimal duration of pharmacological therapy has not been well established. In randomized-controlled trials, the duration of vasoactive drugs has varied between 8 h and 6 days .
There was a major agreement that an appropriate length of therapy would be anywhere between 2 and 5 days depending on control of hemorrhage and the presence or absence of predictors of rebleeding .
The combination of endoscopic therapy and vasoactive drugs is more effective than the isolated use of either of these options alone, because it combines the local haemostatic effect on the varices induced by endoscopic treatment and the portal hypotensive effect achieved with drugs. This combination is currently considered the standard of care in AVB .
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 184
- Acute esophageal varices bleeding
- Liver cirrhosis
- Initial failure to control variceal bleed on endoscopy
- Other causes of GIT bleeding
- Hepatocellular carcinoma
- Portal vein thrombosis
- Renal dialysis and hepatorenal syndrome
- History of myocardial infarction
- Pregnancy or lactation
- Allergy to octreotide
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 2 Days of octreotide infusion Octreotide - 5 Days of octreotide infusion Octreotide -
- Primary Outcome Measures
Name Time Method Esophageal varices rebleed within 5days after control of initial bleed with in 5 days after controlof initial bleeding 5 days Rebleeding means
1. Recurrence of hematemesis or melena after bleeding control
2. Sustained tachycardia more than 100 beat/ min and sudden drop of systolic blood pressure less than 100
3. A drop in hemoglobin by more than 20 percentage points from baseline
4. Transfusion of \>2 unites packed red blood cells after endoscopic intervention of variceal bleeding
- Secondary Outcome Measures
Name Time Method Esophageal varices rebleed at 5 days and 6 weeks after control of initial bleed 5 days - 6 weeks after control of initial bleeding 5days-6weeks rebleed means
1. Any new episode of hematemesis, melena, or hematochezia (with sustained tachycardia more than 100 beat/min and drop of systolic blood pressure less than 100)
2. Drop in hemoglobin by more than 20 percentage points OR the need for \>2 units packed red blood cells