논평참조 : 식도정맥류 출혈 환자에서 내시경결찰술과 Terlipressin 및Octreotide 병합 요법의 재출혈 예방에 대한 무작위 전향연구

• Published in: Clinical and molecular hepatology Vol. 12; no. 3; pp. 385 - 393
• Main Authors: 조성범, Sung Bum Cho, 박강진, Kang Jin Park, 이정수, Jung Soo Lee, 이완식, Wan Sik Lee, 박창환, Chang Hwan Park, 주영은, Young Eun Joo, 김현수, Hyun Soo Kim, 최성규, Sung Kyu Choi, 유종선, Jong Sun Rew, 김세종, Sei Jong Kim
• Format: Journal Article
• Language: Korean
• Published: 대한간학회 25.09.2006
• Subjects: endoscopic; Esophageal varix bleeding; Prevention & control; Terlipressin; Octreotide; Hemostasis; 식도 정맥류
• ISSN: 2287-2728; 2287-285X

Background/Aims: Terlipressin and octreotide had been used to control acute variceal bleeding and to prevent early rebleeding after endoscopic hemostasis. We compared the efficacy and safety of terlipressin and octreotide combined with endoscopic variceal ligation (EVL) for the treatment of acute esophageal variceal bleeding and we evaluated their clinical significance as related to rebleeding. Methods: The eighty eight cirrhotic patients were randomized to the terlipressin group (n=43; 2 mg i.v. initially and 1 mg i.v. at every 4 hours for 3 days) or the octreotide group (n=45; continuous infusion of 25 μg/h for 5 days) combined with EVL for the treatment of acute esophageal variceal bleeding. Results: The initial hemostasis rates were 98% (42/43 cases) in the terlipressin group and 96% (43/45 cases) in the octreotide group. The 5-day and 42-day rebleeding rates were 12% (5/43 cases) and 28% (12/43 cases), respectively, in the terlipressin group and 9% (4/45 cases) and 24% (11/45 cases), respectively, in the octreotide group. No significant difference was demonstrated between the terlipressin and octreotide groups. The mortality at 42 days was similar in both group, but a high mortality rate (48%) was shown to be related to 42-day rebleeding. The risk factors related to 42-day rebleeding were Child-Pugh class C (aOR=30.2, 95% CI=7.7-117.9), ascites above grade II (aOR=6.6, 95% CI=2.2-19.2) and advanced hepatocellular carcinoma (aOR=4.6, 95% CI=1.1-18.9). Conclusions: Comparing terlipressin and octreotide combined with EVL showed them to be equally safe and effective therapeutic agents in patients with acute esophageal variceal bleeding. The high risk factors related to early rebleeding were poor liver function and advanced hepatocellular carcinoma.