The Role Of Sandostatin In Prevention Early Variceal Rebleeding During Endoscopic Variceal Sclerotherapy: A Randomized Clinical Trial

[Background and objective] Esophageal variceal bleeding(EVB) is a serious and emergent disease of digestive system.Although Endoscopic variceal sclerotherapy (EVS) is an effective solution for it , while the rebleeding rate of esophageal varices (REV) after EVS is still high ,which is one of the most important cause of death from hepatic cirrhosis and portal hypertension . The early rebleeding of esophageal varices(EREV) could lead to more serious clinical outcome. To prevent REV and EREV is crucial. The main cause of EREV is the comprehensive effect of portal hypertension and the ulceration of injection point . According that octreotide can lower portal pressure , it was used to prevent EREV together with EVS. At the sametime , we observed the formation of esophageal ulcer and the factors which could influence EREV.[Methods and materials] Sixty patients were enrolled in our study and randomly divided into treated group and control group with 30 patients respectively. Each patient underwent scheduled or emergent EVS , once every seven days untill the extinction of esophageal varices . Sclerosing agent (1% aethoxysklerol )was injected into each varice with about 10 ml for each time, and totally not more than 30ml each EVS . The treated group received subcutaneous injection of octreotide (0. Img once per 8 hours) on the 4th, 5th and 6th day after the first 3 EVS respect]vely. The information of each patients' gender, age, complications, stage of esophageal varices, number of EVS, dosage of sclerosing agent, outcome of esophageal varices, blood transfusion , early recurrence of esophageal variceal bleeding, esophageal ulcer, heart rate, diameter of main portal tract, liver function, blood glucose were collected.We described data with mean 卤standard deviation(X SD) ,median (Md) , column chart and pie chart . Student' s t-test, X2 analysis , fisher' s exact test , rank correlation analysis and logistic regression analysis were performed as appropriate .All P values were significant at 0.05 level .[ Results ] The treated and control groups were evenlybalanced for gender (7M. 000), age (7M). 4121), heart rate(7^0.3033), blood glucose( 7M). 8764), main portal tract ( /M). 5384), liver function( /M). 2772), stage of esophageal varices( P=Q. 8245), course( P=Q. 6100), times of EVB( P=0.0528), etiological factor( P=0.668), history of operation( P=O.731), gastric varices( P=O. 195), complication( TM.OOO), embolization in portal ( P=0. 706 ). The number of EVS (/M). 3938), duration of hospitalization( P=0. 0519), outcome of esophageal varices ( P=0. 6681), Esophageal ulcer( P=0.68) and EREV( P=0.195) in each group has no statistical difference. The two managements had no significantly different effects on patients' blood glucose, diameter of main portal tract, liver function. The heart rate of posttherapy was lower than that of pretherapy (treated group P= 0.0114, control group P= 0. 0411). The duration of hospitalization of treated group was shorter than control group(29. 1 6. 98 days versus 33.47 9.83 days). One patient in treated group suffered from EREB (incidence 3.33%), compared with five in control group (incidence 16.67%). Blood transfusion was observed to be a significant factor which influenced EREV (P<0. 05, coef. 0. 301/0. 281). There was no statistical difference of early esophageal variceal rebleeding rate between the treated group and control group (P=0. 074).[Conclusion] EVS combined with octreotide could lower theearly esophageal variceal rebleeding rate and shorten duration of hospitalization; The esophageal ulceration rates in the treated group were the same as that in the control group.