No mortality difference following treatment with terlipressin or somatostatin in cirrhotic patients with gastric variceal hemorrhage.

BACKGROUND/AIMS: The aim of this study was to compare the efficacy of terlipressin versus somatostatin as adjuvants to endoscopic treatment in cirrhotic patients with gastric variceal bleeding.

PATIENTS AND METHODS: The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to enroll patients who were discharged with International Classification of Diseases, 9th Revision, Clinical Modification diagnoses of cirrhosis and who underwent gastric variceal sclerotherapy for gastric variceal bleeding between January 1, 2007, and December 31, 2007. We observed treatment outcomes and identified clinical factors associated with mortality.

RESULTS: In total, we enrolled 311 cirrhosis patients who underwent sclerotherapy for active gastric variceal bleeding. Among them, 218 patients received terlipressin, and 93 patients received somatostatin. The overall 30 day mortality rate was 13.2% (41/311). A total of 78 (25.1%) patients underwent second-look endoscopy, but only 12 (7%) needed a second course of gastric variceal sclerotherapy. The overall 30-day mortality rates for patients treated with terlipressin and somatostatin were 13.3% and 12.9%, respectively, showing no statistically significant differences between outcomes in the two treatment groups (P = 0.672). The risk of 30-day mortality was significantly higher in patients with hepatocellular carcinoma (HR: 3.257, 95% CI: 1.640-6.469, P= 0.001), acute renal failure (HR: 6.261, 95% CI: 2.376-16.499, P< 0.001), or hepatic encephalopathy (HR: 3.091, 95% CI: 1.430-6.680, P= 0.004).

CONCLUSIONS: Mortality rates did not differ significantly between cirrhosis patients with acute gastric variceal bleeding who received somatostatin or terlipressin as adjuvants to endoscopy.