Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
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Review Meta Analysis Comparative Study
Somatostatin, somatostatin analogues and other vasoactive drugs in the treatment of bleeding oesophageal varices.
Somatostatin and its analogues have been compared with a variety of other treatments for the treatment of variceal bleeding in cirrhotic patients. Meta-analyses of studies comparing somatostatin or octreotide with vasopressin or terlipressin have shown that somatostatin is somewhat superior to vasopressin and equivalent to terlipressin in controlling bleeding and has significantly fewer side effects; no difference in mortality was observed. Octreotide was somewhat better than vasopressin and terlipressin in controlling bleeding, with similar mortality. ⋯ Nine trials have compared endoscopic therapy with therapeutic regimens combining endoscopic treatment with somatostatin, octreotide or vapreotide. Meta-analysis show that the combined regimens increase the 5 days bleeding control rate of endoscopic treatments by over 20%, although there is no difference in mortality. Comparisons of somatostatin and octreotide with combined regimens of sclerotherapy + somatostatin and sclerotherapy + octreotide have shown that the combined regimens were better than drug treatments alone in controlling bleeding and preventing early rebleeding, while complications were significantly less frequent with drug therapy.
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A general characteristic of GEP endocrine tumours is that vast majority produce and secrete a multitude of peptide hormones and amines. The rarity of these types of tumours, their possible episodic expression and the variable clinical symptoms, are the reasons why patients are often diagnosed late in the advanced stages of the disease. For these reasons, the patients with advanced metastatic disease should be treated aggressively with medical and surgical therapies aimed at reducing both symptoms and complications through strategies that reduce tumour bulk and block hormonal effects. ⋯ Biotherapy, with interferon and somatostatin analogs has been demonstrated to have a significant antitumor effect and causes an improvement of symptoms in patients with functioning neuroendocrine tumours. Furthermore, these drugs produce a notable improvement in the quality of life. Radioactive targeting therapy is the most promising new treatment modality for patients who have SST receptor positive tumours.