Efecto hemodinámico esplácnico de somatostatina y octreótido en cirróticos: Estudio con ultrasonografía Doppler

Aim: Doppler-ultrasound assessment of the splanchnic hemo dynamic effects of intravenous somatostatin and octreotide ad ministration. Material and method: forty-five cirrhotic patients with esophageal varices were randomized to receive 1-hour intra venous somatostatin (SOM, 250 g), octreotide (OCT, 50 g), or placebo (PLA). In baseline and at 15, 30, 45 and 60 minutes of infusion, mean velocity, congestion index, flow volume and diam eter of the portal vein, as well as the superior mesenteric artery resistivity index, were measured. Plasma bradykinine and vasoac tive intestinal peptide (VIP) concentrations were also measured at baseline and at 30 and 60 minutes. Results: while placebo caused no changes in any of the venous and arterial parameters, SOM and OCT caused a sustained de crease in portal vein velocity (-19.41 vs. -11.19%) and flow (-22.79 vs. -12.33%), and an increase in the congestion index (+17.5 vs. +7.5%) and resistivity index of the superior mesenteric artery (+7.18 vs. +6.16%) with respect to baseline (p < 0.05). These changes were already evident at 15 minutes and remained unchanged during the time of the study period. With respect to OCT, SOM caused a high er reduction in mean velocity and flow of the portal vein, with no sig nificant differences for congestion index and mesenteric artery resis tivity index, both increased by SOM and OCT. Plasma bradykinine and VIP concentrations remained unchanged in the three groups. Conclusions: at therapeutic doses, intravenous somatostatin and octreotide reduce portal vein velocity and flow, and increase portal vein congestion index and superior mesenteric artery resis tivity index. Somatostatin causes a higher portal flow reduction than octreotide in spite of a similar splanchnic arterial effect.