Early Administration of Vapreotide for Variceal Bleeding in Patients with Cirrhosis

Background In patients with cirrhosis, pharmacologic or endoscopic treatment may control variceal bleeding. However, the effects of early administration of a somatostatin analogue followed by endoscopic treatment are unknown. Methods We studied the effects of treatment with vapreotide, a somatostatin analogue, begun before endoscopic treatment in 227 patients with cirrhosis who were hospitalized for acute upper gastrointestinal bleeding. The patients were randomly assigned to receive vapreotide (a 50-μg intravenous bolus followed by an infusion at a rate of 50 μg per hour for five days) or placebo within a mean (±SD) of 2.3±1.5 hours after admission. The patients received endoscopic treatment a mean of 2.6±3.3 hours after the infusion was begun. After the exclusion of 31 patients whose bleeding was not caused by portal hypertension, there were 98 patients in each group. Results At the time of endoscopy, active bleeding was evident in 28 of 91 patients in the vapreotide group (31 percent), as compared with...