Upper GI bleed: varices: octreotide or somatostatin reduces transfusion requirements.

Clinical bottom line (level 1a)

  1. Patients suspected of bleeding from oesophageal varices who receive somatostatin or octreotide, compared with placebo, require fewer blood transfusions (on average two fewer) and fewer units of blood (on average one fewer) over the next month.
  2. There is no clear effect on death, need for balloon tamponade, failure to control initial haemostasis or subsequent number of rebleeds.
Gotzsche : In the Cochrane Library, Issue 3, 1999. Oxford: Update Software 1999; 3: -
Expires July 2003

The study

Systematic review of randomised controlled trials of
  • Patients: suspected of acute bleeding from oesophageal varices
  • Intervention: somatostatin (typically bolus 250 µ g, followed by 250 µ /hour for 5 days) or octreotide (25-50 µ g/hour for 5 days) compared with placebo
  • Outcome: survival, blood transfusions, use of balloon tamponade, rebleeding


Articles found in all using MEDLINE, 1966 to 1997 (search terms: somatostatin or octreotide with variceal, varices, bleed#, h?emorrhage, ?esophag#, h?ematemesis, mel?ena ) and scanning reference articles and reviews, abstracts from conferences and contacting pharmaceutical companies and authors

Selection criteria: as above- further information in text
Appraisal criteria: detailed in text
Articles excluded if: quasi-randomisation, studied rebleeding in stable patients

seven trials (four double-blind) involving 820 patients
Studies were heterogeneous for control of initial haemostasis, rebleeding and use of balloon tamponade

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
death 2-6 weeks 85/405
(21.0%)		 1.04
(0.74 to 1.46) 		-150
(NNT = 22 to infinity;
NNH = 14 to infinity)
balloon tamponade 2-6 weeks 41/164
(25.0%)		 0.59
(0.21 to 1.70) 		12
(NNT = 5 to infinity;
NNH = 9 to infinity)
failing initial haemostasis 2-6 weeks 142/405
(35.1%)		 0.66
(0.32 to 1.37) 		11
(NNT = 5 to infinity;
NNH = 13 to infinity)
rebleed 2-6 weeks 76/301
(25.2%)		 0.73
(0.30 to 1.79) 		18
(NNT = 6 to infinity;
NNH = 8 to infinity)

  • mean difference in number of transfusions (95% CI): -1.8 (-1.6 to -0.76).
  • mean difference in number of blood units used (95% CI): -1.2 (-1.6 to -0.80).

    Citation

    1. Gotzsche PC, : Somatostatin or octreotide versus placebo or no treatment in acute bleeding oesophageal varices (Cochrane Review). In the Cochrane Library, Issue 3, 1999. Oxford: Update Software 1999; 3: -
    Contributor: Chris Ball and Clare Wotton, July 2000
    Reviewer:

    Clinical Question.
    Patient upper GI bleed
    Intervention or Exposure octreotide or somatostatin
    Comparison placebo
    Outcome death, blood transfusion, rebleeds