Original Contribution
The American Journal of Gastroenterology (2007) 102, 1397–1405; doi:10.1111/j.1572-0241.2007.01262.x
A 3-Month Course of Long-Acting Repeatable Octreotide (Sandostatin LAR) Improves Portal Hypertension in Patients With Cirrhosis: A Randomized Controlled Study
Laurent Spahr MD2, Emiliano Giostra MD1, Jean-Louis Frossard MD1, Isabelle Morard MD1, Gilles Mentha MD2 and Antoine Hadengue MD1
- 1Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland
- 2Transplantation Unit, University Hospital, Geneva, Switzerland
Correspondence: Laurent Spahr, M.D., Gastroenterology and Hepatology, University Hospital, 24, Rue Micheli-du-Crest CH-1211, Geneva 14, Switzerland.
Received 17 November 2006; Accepted 27 February 2007.
Abstract
OBJECTIVE:
In patients with cirrhosis, acute octreotide administration may transiently decrease the hepatic venous pressure gradient (HVPG). Information on long-term effects of octreotide is limited and controversial. We evaluated portal and systemic hemodynamics following a prolonged administration of long-acting octreotide in patients with cirrhosis.
METHODS:
Eighteen cirrhotic patients (alcoholic 12; age 55 yr [44–69]; Pugh's score 7.8; HVPG 17.3 mmHg [12–22]), no steatohepatitis on histology, were randomized to intramuscular octreotide 20 mg (group A) q 4 wk for 3 months or placebo (group B) in a double-blind fashion. At baseline and 3 months, we measured the HVPG, systemic hemodynamics, endothelin-1 (ET-1), and vascular endothelial growth factor (VEGF) in hepatic venous blood.
RESULTS:
Patients remained compensated except for one episode of infection in each group. At 3 months, the HVPG decreased in group A but not in group B (16.5 
1.3 to 11.8 1.5 mmHg, P < 0.01; 18.2 1 to 17 1.1 mmHg, P = 0.4). Systemic hemodynamics and liver function remained unchanged. In group A, but not in group B, VEGF decreased (21.2 4.7 to 13.7 3.5 pg/mL, P < 0.01; 22.5 7.8 to 19.2 5.4 pg/mL, P = 0.4). ET-1 remained stable. Changes in HVPG and VEGF were correlated (r = 0.49, P < 0.05).
CONCLUSIONS:
Three months of long-acting octreotide in selected cirrhotic patients with portal hypertension decreases the HVPG independent of systemic hemodynamics and liver function. The decrease in VEGF blood levels suggests an improvement in splanchnic hyperemia.
