Somatostatin or Octreotide Not Effective in Decreasing Mortality or
Transfusion in Acute Esophageal Varices Hemorrhage
14yo boy is admitted to the PICU with acute esophageal varices hemorrhage on an octreotide
drip. Does this therapy decrease mortality or reduce transfusion requirement?
Clinical Bottom Lines
1. Acute variceal hemorrhage in the pediatric population is rare.
2. Randomized, controlled data regarding the use of somatostatin or octreotide in the
management of acute variceal hemorrhage are only available in the adult literature.
3. Somatostatin does not decrease mortality compared with placebo in the management of acute
variceal hemorrhage in adults (1,2).
4. The study summarized suggested an increased transfusion requirement with somatostatin
compared with placebo in the management of acute variceal hemorrhage in adults. There was
significant heterogeneity between studies with respect to this finding. The value of
somatostatin or octreotide in the management of patients with acute variceal hemorrhage is
Summary of Key Evidence
1. 86 patients with suspected bleeding esophageal varices and verified or suspected cirrhosis of
the liver were randomized in a double-blinded, controlled trial to receive somatostatin or
placebo. Placebo and control groups had similar characteristics at the onset. (1)
2. Outcome measures after six weeks were survival, blood transfusions, episodes of bleeding,
days with bleeding, use of Sengstaken-Blakemore tube, and complications. Analysis was on
an intention to treat basis. (1)
3. No significant differences were found between any outcome measures between the two
groups. There were 16 deaths out of 42 patients in the somatostatin group compared with 16
deaths out of 44 patients in the placebo group (p=1.00). There was an average of 8
transfusions per patient given to patients in the somatostatin group compared with an average
of 5 transfusions per patient in the placebo group (p=0.07). (1)
4. This study had insufficient power for a type II error of p=0.10. (1)
Somatostatin is a 14 amino acid hormone. Octreotide is an 8 amino acid derivative of
somatostatin with a much longer half-life. Both have the same therapeutic properties.
Somatostatin and octreotide reduce portal blood flow and hepatic venous pressure gradient
but the effect on intra-esophageal pressure is more equivocal in experimental studies (2).
Both drugs are well-tolerated. The major adverse effect is hyperglycemia with rare reports
of insulin requirement for management (3).
The Cochrane Database Review with a meta-analysis of 820 adult patients also found no
difference in mortality with the use of somatostatin or octreotide vs. placebo (OR 1.04,
95%CI 0.74-1.46). It reported a positive effect with drug for number of transfusions per
patient, corresponding to 1.2U of blood product saved per patient (95%CI 0.8-1.6). This is
likely not a clinically significant effect.(2)
The use of somatostatin or octreotide in the management of acute non-variceal hemorrhage
appears to significantly reduce the risk of continued bleeding but not alter the need for
surgery nor decrease the transfusion requirement significantly. The effectiveness of the drug
was limited to the subgroup with peptic ulcer bleeding. (3)
1. Gotzsche PC, Gjorup I, Bonnen H, Brahe NEB, Becker U, Burcharth F. Somatostatin v
placebo in bleeding esophageal varices: randomised trial and meta-Analysis. BMJ 1995; 310:
2. Gotzsch PC. Cochrane Database of Systematic Reviews: Somatostatin or octreotide for acute
bleeding esophageal varices. The Cochrane Library 1999; Vol 2.
3. Siafakas C, Fox VL, Nurko S. Short communication: Use of octreotide for the treatment of
severe gastrointestinal bleeding in children. J Pediatr Gastroenterol Nutr. 1998;26: 356-9.
4. Imperiale TF, Birgisson S. Somatostatin or octreotide compared with H2 antagonists and
placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a
meta-analysis. Ann Intern Med. 1997; 127: 1062-1071.
CAT Author: Angela Punnett, MD
CAT Appraisers: <Reviewers>, MD
Date appraised: 7/26/99