One versus five days of octreotide infusion for acute esophageal variceal bleeding: a randomized controlled trial
Issued Date
2025-01-01
Resource Type
ISSN
00029270
eISSN
15720241
Scopus ID
2-s2.0-105028559824
Pubmed ID
41090987
Journal Title
American Journal of Gastroenterology
Volume
Publish Ahead of Print
Start Page
1
End Page
29
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Gastroenterology Vol.Publish Ahead of Print (2025) , 1-29
Suggested Citation
Chirapongsathorn S., Chang A., Malikhao S., Wanichagool D., Manasirisuk W., Kaosombatwattana U., Rattanasupar A., Polpanich N., Noophun P., Suksamai A., Bunnag K. One versus five days of octreotide infusion for acute esophageal variceal bleeding: a randomized controlled trial. American Journal of Gastroenterology Vol.Publish Ahead of Print (2025) , 1-29. 29. doi:10.14309/ajg.0000000000003791 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114102
Title
One versus five days of octreotide infusion for acute esophageal variceal bleeding: a randomized controlled trial
Corresponding Author(s)
Other Contributor(s)
Abstract
Background and Aims: – The optimal duration of octreotide infusion for esophageal variceal bleeding remains unclear. We aimed to compare the efficacy of 1-day versus 5-day octreotide infusion combined with endoscopic therapy, with the primary outcome of early (5-day) re-bleeding under a non-inferiority framework and secondary outcomes of 6-week re-bleeding and all-cause mortality.Methods: – This nationwide, multicenter, non-inferiority, open-label, randomized, controlled trial included 220 patients with cirrhosis and acute esophageal variceal bleeding who underwent endoscopic band ligation in five tertiary-care and three university-based hospitals across Thailand. They received a 1-day (n=109) or 5-day (n=111) regimen of continuous octreotide infusion after successful endoscopy. Re-bleeding, transfusion requirements, and mortality were assessed.Results: – The majority of participants were men (180/220), and the average age was 56 years. The 5-day re-bleeding (1.83% vs. 1.80%, p≥0.99), 6-week re-bleeding (8.26% vs. 10.81%, p=0.52), and 6-week all-cause mortality (5.50% vs. 6.31%, p=0.80) rates were similar between the 1- and 5-day groups. The event-rate difference in early re-bleeding was 0.03%, indicating non-inferiority (95% CI, 3.50–3.56%). Patients in the 1-day group required significantly fewer blood transfusions and had a shorter time to oral diet and shorter hospital stay.Conclusions: – Following successful endoscopic band ligation, the 1-day regimen of octreotide had a non-inferior effect compared to the standard 5-day regimen in the prevention of 5-day re-bleeding and exhibited no significant differences in the prevention of 6-week re-bleeding and all-cause mortality.