Esophageal Variceal Rebleeding Clinical Trial
BACKGROUND: Previous studies showed that the combination of endoscopic therapy with
vasoconstrictor is better than either vasoconstrictor or endoscopic therapy alone in
achieving the successful hemostatsis of acute variceal bleeding. The rationale of using
vasoconstrictor is to enhance the efficacy of hemostasis by endoscopic therapy. Nowadays,
endoscopic variceal ligation (EVL) has replaced endoscopic injection sclerotherapy (EIS) as
the endoscopic treatment of choice in the arresting of acute esophageal variceal hemorrhage.
EVL alone can achieve hemotasis up to 97% even in cases of active variceal hemorrhage.
However, early rebleeding due to ligation-induced ulcer may be encountered. It appears that
prevention of esophageal ulcers and bleeding by a proton pump inhibitor may be more logical
than using a vasoconstrictor after cessation of bleeding by EVL.
Thus, the investigators designed a controlled trial to compare the initial hemostasis, early
rebleeding rate in cirrhotic patients presenting with acute variceal bleeding receiving
either emergency EVL plus vasoconstrictor infusion or losec infusion for 5 days.
Methods of treatment:
Group 1: Somatostatin 250μg slow bolus IV infusion followed by 250μg per hour (6mg/ 24
hours) or Terlipressin 2mg bolus was instituted on enrollment followed by 1mg per 6 hours
for 5 days. The use of either somatostatin or glypressin was at the discretion of doctors in
charge. Group 2: Pantoloc 20 mg intravenously per day was instituted on enrollment and
continued for 5 days.
Definition of initial hemostasis:
Initial hemostasis was defined as achieving a 24h bleeding-free period within the first 48h
after treatment together with stable vital signs based on Baveno consensus criteria.
Very early rebleeding was defined as: UGI bleeding occurred after initial hemostasis and
within 5 days after enrollment. UGI bleeding was proven to be from esophageal varices.
Treatment failure is defined as failure to control acute bleeding episodes or very early
rebleeding.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment