Background: Lanreotide, a new long-acting somatostatin analogue, has been shown to inhibit the meal-stimulated increase of splanchnic blood flow in healthy volunteers. To date, similar data in patients with liver cirrhosis have not been available. We have examined the effect of lanreotide compared with placebo on meal-stimulated portal blood flow in patients with liver cirrhosis using Doppler ultrasound. Methods: 20 cirrhotic patients (placebo n = 12, lanreotide n = 8) with proven portal hypertension were studied after an overnight fast. Lanreotide, at a dose of 100 µg/h, was infused intravenously over 7 h after a 1-hour basal period. In parallel to the intravenous infusion, a liquid test meal (Ensure plusTM, 1.5 kcal/min) was perfused for 7 h through an intraduodenal tube at a rate of 3 ml/min. Blood pressure, heart rate and portal vein blood flow (PVF, ml/min, Doppler technique) were determined at regular intervals. Results: Baseline PVF amounted to 725 ± 182 ml/min in the placebo and to 917 ± 252 ml/min in the lanreotide group (n.s.). The meal-stimulated increase in PVF was blunted by lanreotide (AUC, %·min): 62,709.6 ± 6,817 (placebo) vs. 45,237 ± 2,507 (lanreotide), p < 0.05. Lanreotide also blunted the postprandial increase in heart rate for the first 2 h of meal perfusion. Conclusions: Because of potent inhibition of postprandial splanchnic hyperemia in patients with liver cirrhosis, lanreotide may be useful in the treatment of complications of portal hypertension.

Abstract Objective: To assess the efficacy of long term octreotide as adjuvant treatment to programmed endoscopic sclerotherapy after acute variceal haemorrhage in cirrhotic portal hypertension. Design: Randomised clinical trial. Setting: University hospital. Subjects: 32 patients with cirrhotic portal hypertension. Interventions: Programmed injection sclerotherapy with subcutaneous octreotide 50 μg twice daily for 6 months, or programmed injection sclerotherapy alone. Main outcome measures: Episodes of recurrent variceal bleeding and survival. Results: Significantly fewer patients receiving combined octreotide and sclerotherapy had episodes of recurrent variceal bleeding compared with patients given sclerotherapy alone (1/16 v 7/16; P=0.037, Fisher's exact test), and their survival was significantly improved (P<0.02, log rank test); this improvement was maintained for 12 months after the end of the study. Combined treatment also resulted in a sustained decrease in portal pressure (median decrease −6.0 mm Hg, interquartile range −10 to −4.75 mm Hg, P=0.0002) compared with sclerotherapy alone (median increase 1.5 mm Hg, interquartile range 0.25 to 3.25 mm Hg), as well as a significant improvement in liver function as assessed by plasma concentrations of bilirubin, albumin, and alanine aminotransferase and by hepatocyte metabolism of aminopyrine labelled with carbon-14. Conclusion: Long term octreotide may be a valuable adjuvant to endoscopic sclerotherapy for acute variceal haemorrhage in cirrhotic portal hypertension. Key messages The long term use of vasoactive drugs as adjuvant treatment after endoscopic sclerotherapy or ligation for acute variceal haemorrhage has been suggested to reduce the risk of variceal rebleeding This randomised trial found that the addition of long term octreotide to endoscopic treatment reduced the rate of recurrent variceal haemorrhage in patients with cirrhotic portal hypertension Octreotide also improved survival after acute variceal haemorrhage in such patients Long term administration of somatostatin analogues offers a promising treatment to prevent recurrent variceal haemorrhage