Octreotide and bleeding oesophageal varices: new indication. Nothing new

(1) Octreotide, a synthetic somatostatin analogue, is now also indicated for emergency treatment of ruptured oesophageal varices pending endoscopic treatment. (2) The assessment file in this indication is limited. (3) The two available comparative trials show no difference in efficacy compared with terlipressin, but their statistical power was low. Octreotide has not been compared with somatostatin, the efficacy of which is not clearly established either. (4) A placebo-controlled trial, published only as an abstract, showed no specific activity of octreotide on bleeding oesophageal varices. (5) There are few reports of adverse effects with octreotide. There is nothing to suggest that its adverse effects differ from those of somatostatin, when the drug is used in patients who cannot tolerate terlipressin. Octreotide is no easier to administer than somatostatin or terlipressin.