급성 식도정맥류 출혈 환자에서 Somatostatin과 Vasopressin의 치료효과 비교 : A Prospective Randomized Trial

Background/Aims: Although endoscopic band ligation or injection sclerotherapy are the current standard therapies for bleeding esophageal varices, the best method for initial control is unclear. The aim of this prospective study was to compare the efficacy and toxicity of somatostatin and vasopressin in the management of esophageal variceal hemorrhage. Methods: From March, 1997 to September, 1998, 28 consecutive cirrhotic patients admitted to the Yonsei Medical Center because of active variceal bleeding were included in this trial. The patients were randomized to receive either somatostatin (15 patients) or vasopressin (13 patients) for 48 hours. Results: There were no significant differences between the two treatment groups in relation to Child's classification, amount of bleeding before randomization and units of blood transfused during therapy. Initial control of bleeding was achieved in 13 (86.7%) patients receiving somatostatin and in 10 (76.9%) of those treated with vasopressin. However, two patients in the somatostatin group and two in the vasopressin group bled again during treatment. Therefore complete control of bleeding during the 48 hours of therapy was achieved in 11 (73.4%) patients treated with somatostatin and in eight (61.5%) of those receiving vasopressin. Differences were observed in complications associated with each therapy. Vasopressin produced complications in four patients (chest pain in two, hypertension in one and hyponatremia-induced seizure in one) while somatostatin produced minor complication in one patient. Conclusions: This study suggests that somatostatin is efficacious in controlling acute hemorrhage from esophageal varices and has a lower risk of adverse effects than vasopressin.