Shorter and Economical Terlipressin Regime for Esophageal Variceal Bleeding

Aims: To compare the effectiveness of treatment with Terlipressin for 12-hour and for 72-hour in inhibiting the episodes of rebleeding once endoscopic band ligation is done.

Study Design: Randomized Clinical Trial.

Place and Duration of Study: Department of Medicine (Unit of Gastroenterology and Hepatology) at District Headquarter (DHQ) Teaching Hospital, Sahiwal (Pakistan) during February to April, 2018.

Methodology: Patients with cirrhosis presenting to emergency of our hospital with upper GI (gastrointestinal) bleeding was given Terlipressin 2 mg IV bolus, followed by 1mg every 6-hourly until endoscopy was done. Those with proven esophageal varices as the cause of bleeding were managed with band ligation and were enrolled. 54 enrolled patients were randomized into 14 (25.9%) in control Group-A and 40 (74.1%) in experimental Group-B. Group-A was treated for 72-hour with Terlipressin while Group-B was treated for 12-hour. Both groups were observed for episodes of rebleeding for at least 5 days.

Results: Rebleeding was observed in 1 (7.1%) patient in Group-A and 2 (6.7%) in Group-B during the 5-day period. All 3 (5.5%) underwent second endoscopy. The Group-A patient and 1 (3.3%) of 2 Group-B patients showed ulcers around the sites of band ligation as cause of bleeding. The second patient in Group-B showed esophagus varices requiring repeated banding.

Conclusion: 12-hour Terlipressin treatment along with banding is cheaper while as effective as 72-hour regime.