Comparison of Octreotide with Placebo after Successful EVL to Prevent Rebleeding: A Randomized Controlled Trial

The standard treatment for bleeding esophageal varices typically combines pharmacotherapy with endoscopic variceal ligation (EVL). As a general practice, vasoactive drugs are administered for 3-5 days, following banding to reduce the risk of rebleeding. However, the necessity of continuing these vasoactive drugs after definitive therapy remains uncertain, with no conclusive results available. This study aims to compare the efficacy of octreotide against a placebo after EVL in variceal bleeding.

This study was a prospective, double-blinded, randomized controlled trial conducted at a tertiary care institute in India. A total of 270 patients were recruited. All patients underwent EVL for variceal bleeding and were subsequently randomized into two groups. Patients in group A did not receive any drug, while patients in group B received octreotide for 3 days. They were monitored for 5 days to assess instances of very early rebleeding.

The baseline characteristics of patients in both groups were comparable. There was no significant difference observed between the two groups regarding very early rebleeding (within 5 days). One patient in each group (2/270) had very early rebleeding (p = 1.00). Although the cost-effectiveness of discontinuing octreotide immediately after EVL was not quantified, it was noted that the use of octreotide for 3 days resulted in increased demands on manpower, materials, finances, and prolonged hospital stays.

Octreotide does not reduce the rates of very early rebleeding after EVL. Therefore, it can be safely discontinued after EVL, which could lead to shorter hospital stays and is more cost-effective.

Kiran P, Nagarajan RK, Theakarajan R, et al. Comparison of Octreotide with Placebo after Successful EVL to Prevent Rebleeding: A Randomized Controlled Trial. Euroasian J Hepato-Gastroenterol 2025;15(1):63-67.