Syed Razi Muhammad, S M Rab.
Results of Treatment with Sclerotherapy and Octreotide in Acute Variceal Bleeding, A Prospective Study of 157 Patients and a Review of Alternate Modalities of Treatment.
Pak J Med Sci Jan ;17(1):31-7.

Background: Acute variceal bleeding is a common emergency in Pakistan with a high risk of rebleeding and death. An early endoscopy is required to confirm the diagnosis as well as to perform some therapeutic procedure such as sclerotherapy or banding. This can be combined with drug treatment such as octreotide. Methods: One hundred and fifty-seven consecutive cases of acute variceal bleeding fulfilling the inclusion criteria were offered early endoscopy and sclerotherapy using 3% ethanolamine oleate. This was immediately followed by a continuous infusion of octreotide (25 ug/hour). Patientswho stayed alive were kept in hospital for a minimum of 5 days after sclerotherapy., Theywere also reviewed two weeks post sclerotherapy. Patients who had rebleeding had further sclerotherapies and the dose of octreotide was increased to 50ug/hour. Results: Two patients died of continued bleeding within 24 hours. Between day two and five, 17 patients had rebleeding. Of these six died of continued bleeding despite treatment. During this period, another six patients died of causes other than hemorrhage. Between 6-15 days, 13 more patients had rebleeding. Seven of these patients continued to bleed despite treatment and died. Another six patients died of other causes between day 6-15. Conclusion: In acute variceal bleeding, combination of early sclerotherapy and octreotide infusion is an effective method of controlling bleeding and preventing early rebleeding.

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