Octreotide for cirrhosis after variceal bleeding

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7144.1607 (Published 23 May 1998) Cite this as: BMJ 1998;316:1607

Authors' claims for octreotide were not justified

  1. D Patch, Senior registrar,
  2. AK Burroughs, Consultant physician
  1. Department of Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London NW3 2QG
  2. Clinical and Cancer Trial Unit, Department of Surgery, Royal Liverpool University Hospital, Liverpool L7 8XP

    EDITOR—The conclusion drawn by Jenkins et al is that octreotide improves liver function, lowers portal pressure, and protects against variceal rebleeding.1 The paper, however, does not justify this conclusion.

    Firstly, the number of patients is too small. The authors state that as long term octreotide had not been used previously in patients with cirrhosis there were no data from which to perform a power calculation. This is incorrect. Primignani et al showed no difference when subcutaneous octreotide or placebo was added for 29 days to sclerotherapy in the prevention of variceal rebleeding in 58 patients.2 In addition, there is a wealth of data that suggest that sclerotherapy reduces the incidence of variceal rebleeding to 50% at one year. The authors could have expected, at best, an additional reduction of 20% with octreotide. Using a β of 20% and an α of 5%, a trial …

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