Terlipressin Administered Only Prior To Endoscopic Therapy in The Management of Bleeding Esophageal Varices Does Not Increase the Risk of Re-bleeding Compared to Standard 3-5 Days Regime

Abstract

Background & Aims: Terlipressin is recommended therapy for 3-5 days in esophageal variceal bleeding. The aim of this study was to determine the feasibility of administering terlipressin only prior to band ligation. Methods: Patients with esophageal variceal bleeding received terlipressin 2mg intravenous bolus followed by 1mg 6 hourly until undergoing endoscopic band ligation. They were monitored for re-bleeding for 5 days. Results: 67 patients, 38 (57%) male and 29 (43%) female, mean age 50+4 years, received terlipressin until undergoing endoscopic band-ligation. Etiology of liver disease was HCV in 62 (92.5%), HBV & HCV in 2 (3%), HCV & ethanol in 2 (3%) and unknown in 1 (1.5%) patient. 13 (19%) patients underwent band ligation after a single 2 mg dose of terlipressin, 16 (24%) after two doses (6 hours therapy), 11 (16%) after 3 (12 hours therapy), 6 (9%) after 4 (18 hours therapy), 6 (9%) after 5 doses (24 hours therapy) and 15 (22%) after more than 24 hours therapy. Banding was done within 12 hours in 40 (60%) patients and within 24 hours in 12 (18%) patients. Endoscopy was delayed beyond 24 hours in 15 (22%) patients due to Sengstaken-Blakemore tube placement, encephalopathy and blood transfusion requirements. 3 (4.9%) patients had rebleeding. Repeat endoscopy showed post-banding ulcers in 2 patients (managed with I.V omeprazole and oral sucralfate). One patient had varices with red signs requiring repeat band ligation. Two patients died due to hepatorenal syndrome and persistent encephalopathy. No drug related adverse effects were noted. Conclusion: Once band-ligation has been performed, terlipressin may be safely discontinued. This can result in reduction in cost of treatment with no significant increase in morbidity and mortality.