Octreotide for acute esophageal variceal bleeding: a meta-analysis

Gastroenterology. 2001 Mar;120(4):946-54. doi: 10.1053/gast.2001.22451.


Background & aims: Studies of octreotide have not demonstrated a consistent benefit in efficacy or safety compared with conventional therapies. This study statistically pooled existing trials to evaluate the safety and efficacy of octreotide for esophageal variceal hemorrhage.

Methods: We identified randomized trials of octreotide for variceal hemorrhage from computerized databases, scientific meeting abstracts, and the manufacturer of octreotide. Blinded reviewers abstracted the data, and a meta-analysis was performed.

Results: Octreotide improved control of esophageal variceal hemorrhage compared with all alternative therapies combined (relative risk [RR], 0.63; 95% confidence interval [CI], 0.51-0.77); vasopressin/terlipressin (RR, 0.58; 95% CI, 0.42-0.81); or no additional intervention/placebo (among patients that received initial sclerotherapy/banding before randomization) (RR, 0.46; 95% CI, 0.32-0.67). Octreotide had comparable efficacy to immediate sclerotherapy for control of bleeding (RR, 0.94; 95% CI, 0.55-1.62), fewer major complications than vasopressin/terlipessin (RR, 0.31; 95% CI, 0.11-0.87), and a complication profile comparable to no intervention/placebo (RR, 1.06; 95% CI, 0.72-1.55). No specific alternative therapy demonstrated a mortality benefit.

Conclusions: These results favor octreotide over vasopressin/terlipressin in the control of esophageal variceal bleeding and suggest it is a safe and effective adjunctive therapy after variceal obliteration techniques. Trials are needed to determine the optimal dose, route, and duration of octreotide treatment.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Esophageal and Gastric Varices / complications*
  • Hemorrhage / drug therapy*
  • Hemorrhage / etiology*
  • Hemorrhage / mortality
  • Hemostatics / adverse effects
  • Hemostatics / therapeutic use*
  • Humans
  • Lypressin / adverse effects
  • Lypressin / analogs & derivatives*
  • Lypressin / therapeutic use
  • Octreotide / adverse effects
  • Octreotide / therapeutic use*
  • Recurrence
  • Terlipressin
  • Vasopressins / adverse effects
  • Vasopressins / therapeutic use


  • Hemostatics
  • Vasopressins
  • Lypressin
  • Terlipressin
  • Octreotide