Octreotide therapy for variceal hemorrhage.

Somatostatin and its analogue, octreotide, produce dramatic decreases in splanchnic arterial blood flow and portal venous pressure while preserving cardiac output and systemic blood pressure. A limited number of prospective randomized clinical trials of somatostatin and octreotide have noted superiority to placebo and equivalence to vasopressin in control of variceal hemorrhage. Moreover, several studies (Saari et al., Kravetz et al., McKee et al.) have reported a significant decrease in morbid side effects when somatostatin or octreotide is used to control variceal bleed. In addition, McKee et al. noted a significant reduction in mortality when octreotide was compared to balloon tamponade therapy for variceal hemorrhage. Somatostatin and octreotide are particularly advantageous in controlling vigorous variceal hemorrhage in hemodynamically unstable patients. This control often enables other effective therapy, endoscopic sclerotherapy and surgical (or radiologic) shunting, to be safely performed.