Somatostatin and Analogues for Acute Non-Variceal Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis of Randomized Trials
CCCF ePoster library. Lu C. Nov 8, 2018; 233428
Clara Lu
Clara Lu
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Abstract
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Introduction

While somatostatin and its analogues are part of standard care for acute variceal upper gastrointestinal (GI) bleeding, their role in acute non-variceal upper GI bleeding remains unclear. As the most recent systematic review addressing this topic was conducted several decades ago, before the advent of endoscopic therapy, an updated synthesis of available data is warranted.

 

Objectives

The aim of this systematic review and meta-analysis is to determine the efficacy and safety of somatostatin and its analogues compared to placebo in adult inpatients with acute non-variceal upper GI bleeding.

 

Methods

We searched the Cochrane Library, MEDLINE, and EMBASE through July 2018 for randomized clinical trials (RCTs) on somatostatin or somatostatin analogues in acute non-variceal upper GI bleeding. We used meta-analytic techniques to generate pooled estimates for mortality, further bleeding (continued bleeding or re-bleeding), successful hemostasis, need for surgery, blood transfusions, adverse effects, and length of stay in hospital. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of the evidence for each outcome.

 

Results

A total of 14 RCTs enrolling 1791 patients met our inclusion criteria. Treatment with somatostatin or analogues compared to placebo probably does not reduce mortality (relative risk [RR] 1.35; 95% CI 0.91, 2.02; P = 0.14; = 0%; moderate quality), further bleeding (RR 0.73; 95% CI 0.47, 1.13; P = 0.16; = 77%; very low quality), need for surgery (RR 0.86; 95% CI 0.62, 1.20; P = 0.37; = 30%; low quality), need for blood transfusion (RR 0.96; 95% CI 0.89, 1.04; P = 0.35; = 0%; moderate quality), adverse effects (RR 1.35; 95% CI 0.56, 3.26; P = 0.51; = 48%; low quality), or length of stay (mean difference [MD] 0.29 days; 95% CI -0.31, 0.89; P = 0.35, = 0%; low quality). However, it may increase successful hemostasis (RR 1.36; 95% CI 1.05, 1.76; P = 0.02; = 85%; low quality) compared to placebo. An increased number of units were transfused per patient in the somatostatin group (MD 0.51 units; 95% CI 0.00, 1.01; P = 0.05; = 33%; moderate quality).

 

Conclusion

In acute non-variceal upper GI bleeding, treatment with somatostatin and its analogues probably increases the likelihood of successful hemostasis, but this benefit failed to translate into benefit for other outcomes. Furthermore, the uncertainty regarding increased mortality is concerning. Given the overall low quality of evidence, further high-quality RCTs are needed to confirm or dispute these observations.

 


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