Somatostatin in the treatment of oesophageal varices

• has been used widely in the treatment of acute bleeding oesophageal varices
• drug is generally given by infusion - has a half-life of 2-3 minutes
• a meta-analysis has collated trials published in English in which somatostatin or octreotide were compared with other vasoactive drugs (vasopressin or terlipressin), slerotherapy or balloon tamponade - the pooled results showed that somatostatin and octreotide were more effective than the other vasoactive drugs in the initial control of acute bleeding but neither appeared to reduce mortality rates (1)
• evidence suggests that the combination of somatostatin or octreotide and endoscopic therapy is more effective than either alone in controlling an initial oesophageal variceal bleed (2)
• a meta-analysis however suggested that the use of somatostatin in acute bleeding oesophageal varices produced an effect that corresponded to one half unit of blood saved per patient (3). The authors suggested that it is doubtful whether this effect is worthwhile

Reference:

1. Gotzsche PC. Somatostatin or octreotide for acute bleeding oesophageal varices (Cochrane Review). In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software.
2. Drug and Therapeutics Bulletin 2000; 38 (5): 37-40.
3. Gotzsche PC, Hrobjartsson A. Somatostatin analogues for acute bleeding oesophageal varices. Cochrane Database Syst Rev 2005; (1):CD000193