Somatostatin: an alternative to sclerotherapy?

The mortality rate of bleeding from oesophageal varices (30-40%) makes it one of the most serious emergencies today. Since in 30-40% of patients varices are actively bleeding, urgent control is mandatory for preventing the patient from dying of hypovolaemic shock.

Various reports have shown the efficacy of injection sclerotherapy, one session controlling bleeding in 75-80% of patients, and a second increasing the success rate to 90-95%. However, the facilities for 24-h endoscopy and the expertise are not always available in the hospital. Therefore, there is a need for an effective stop-gap therapy for controlling variceal bleeding until definitive therapy can be carried out. Comparisons of various drugs have provided conflicting results. It is not clear whether combined vasopressin and nitroglycerin is superior to injection sclerotherapy in the acute control of variceal haemorrhage. A randomized controlled trial has showed somatostatin to be as effective as injection therapy in the control of acute variceal bleeding and incidence of recurrent bleeding in the first 5 days after initiation of therapy.

Somatostatin is a safe and effective treatment for the control of acute variceal haemorrhage and for preventing early rebleeding.