Journal of Pediatric Gastroenterology & Nutrition:
Abstracts: ESPGHAN-NASPGN 5th Joint Meeting
Divisions of Critical Care Medicine and Gastroenterology, Miami Children's Hospital, Miami, Florida.
Background: Patients presenting with esophageal variceal bleeding necessitate immediate medical attention. Emergency sclerotherapy is often employed in such patients to control bleeding. Octreotide, a synthetic analogue of somatostatin, has been effective in the management of adult patients with acute bleeding from esophageal varices as well as in decreasing the need for sclerotherapy. However, its effectiveness in pediatric patients has yet to be established. If effective, octreotide may prove beneficial in the initial treatment of pediatric patients presenting with bleeding esophageal varices in community hospital emergency rooms where physicians trained to perform sclerotherapy may not be readily available.
Methods: We reviewed the charts of all children admitted to our pediatric intensive care unit (PICU) over a two year period who received octreotide therapy for esophageal variceal bleeds. Information retrieved included demographic data as well as previous bleeding episodes and treatment. The dosage, duration, efficacy and adverse effects of the current octreotide therapy were also noted. Descriptive statistics were utilized to describe our data.
Results: From March 1995 to October 1997, six children with portal hypertension (age: 6 mo to 21 years) were admitted to our PICU and experienced a total of 9 episodes of bleeding from esophageal varices. One child presented with α1 antitrypsin deficiency, one with hepatic fibrosis, and four with portal vein thrombosis. One child was admitted three times and another twice. In four of these episodes, an initial bolus dose of octreotide was administered (0.3 to 3 mcg/kg). Octreotide was administered via continuous infusion in all patients at a mean maximum dosage of 2 mcg/kg/hour(range: 0.3 to 4) for a duration of 59 ± 31 hours (range: 2 to 96). Octreotide therapy was deemed effective in seven episodes (78%) of bleeding. During two episodes (22%), additional measures (sclerotherapy and balloon tamponade) were necessary to control bleeding. Additionally, sclerotherapy was also performed in two (22%) patients after the bleeding was controlled with octreotide. Bleeding recurred after octreotide was discontinued in only one patient (11%) who ultimately required surgery. Adverse events during octreotide therapy included mild, transient hypertension occurring during seven episodes (78%) requiring no treatment.
Conclusions: Octreotide therapy appears safe and effective in pediatric patients presenting with bleeding esophageal varices. Early use of octreotide may reduce the need for emergency sclerotherapy and may be particularly useful when skilled personnel to perform emergency sclerotherapy are not readily available.