Terlypressin and endoscopic sclerotherapy control variceal bleeding and prevent early rebleeding in cirrhotic patients

Abstract The efficacy of terlypressin in combination with endoscopic sclerotherapy in the emergency control of bleeding from esophageal varices and in the prevention of early variceal rebleeding in cirrhotic patients was assessed in a multicenter randomized trial. In Phase I, emergency treatment (days 1 and 2), 596 cirrhotic patients with acute bleeding underwent sclerotherapy and were simultaneously treated with terlypressin [2 mg intravenously (IV) every 4 hours for 24 hours, followed by 2 mg IV every 6 hours for 24 hours]. Hemostasis was obtained in 96.9% of patients; 8.3% of patients experienced rebleeding and 5.1% of patients died. In phase II, control of rebleeding , patients with controlled variceal bleeding were randomly divided into two groups. Subjects in group A repeated sclerotherapy on day 7; subjects in group B received sclerotherapy on day 7 together with terlypressin (1 mg IV every 6 hours from day 3 to day 7). Both groups were monitored for 21 days and sclerotherapy was repeated on days 14, 21, and 28. During phase II of the study, rebleeding was observed more frequently in group A than in group B ( P = 0.001) and mortality for severe rebleeding was lower in group B, although this finding was not statistically significant. Thus the combination of terlypressin with standard endoscopic sclerotherapy during the first 7 days after acute variceal bleeding in cirrhotic patients may be more effective than sclerotherapy alone in controlling hemorrhage and in preventing early rebleeding.