Octreotide-assisted endoscopy versus octreotide-assisted TIPS for acute esophagogastric variceal bleeding with and without terlipressin intensification: A real-world study
SITT significantly reduces the risk of rebleeding compared to endoscopy, but it does not lower mortality rates. Adding terlipressin does not offer additional benefits and may increase adverse events.
Where it sits
this study against the rest of the octreotide corpusSummary and findings
This study analyzed the effectiveness of octreotide-assisted endoscopy versus octreotide-assisted TIPS in 656 patients with acute esophagogastric variceal bleeding. The findings indicated that TIPS significantly reduced the risk of rebleeding compared to endoscopy but did not affect mortality rates. The addition of terlipressin did not provide additional benefits and was associated with increased adverse events.
Abstract
<title>Abstract</title> <p>Background Direct comparisons of octreotide (OCT)-assisted endoscopy versus octreotide-assisted TIPS for acute esophagogastric variceal bleeding (AEVB) are lacking, and the benefit of terlipressin supplementation remains unclear. Methods A retrospective cohort of 656 patients with AEVB who received emergency therapy between 2017 and 2025 was analyzed. Patients were grouped based on the following treatment regimens: standard endoscopic therapy (SET; octreotide plus endoscopy), standard interventional therapy (SITT; octreotide plus TIPS and gastric coronary vein embolization), and SET or SITT with additional terlipressin (SET + TP and SITT + TP, respectively). To compare the risk of rebleeding and death, we created three propensity score‑matched cohorts (SET vs. SITT, SET + TP vs. SET, and SITT + TP vs. SITT). Results Compared with SET, SITT significantly reduced the risk of rebleeding within six weeks (HR = 0.31; 95% CI: 0.15–0.65; P = 0.002) and beyond six weeks (HR = 0.23; 95% CI: 0.14–0.38; P < 0.001) but did not reduce the risk of death within six weeks (HR = 0.86; 95% CI: 0.29–2.55; P = 0.782). The addition of terlipressin to SET or SITT did not further reduce the risk of rebleeding or death and was associated with a higher risk of 6-week composite adverse events (rebleeding or death: HR = 3.11; 95% CI: 1.18–8.19; P = 0.015) with SITT + TP. Conclusion SITT reduced the risk of rebleeding but did not reduce the risk of death. The addition of terlipressin provided no additional benefit and tended to increase the risk of adverse events.</p>
Background
The study addresses the management of acute esophagogastric variceal bleeding, a critical condition often requiring immediate intervention. Octreotide and TIPS are established treatments, but their comparative effectiveness, especially with terlipressin intensification, is less clear. This research aims to provide real-world evidence on these interventions.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Without detailed results, it is challenging to compare this study's findings to existing literature or assess the clinical significance of the interventions. The real-world study design suggests observational data, which may be subject to confounding factors.
Key findings
- Not reported in abstract.
Limitations
- Abstract not available
- Preprint, not peer-reviewed
- Details on study design and outcomes not provided
- Potential confounding in real-world study