Long-term use of subcutaneous octreotide reduces variceal bleeding in non-cirrhotic portal hypertension

BACKGROUND: Non-cirrhotic portal hypertension from a portal vein thrombus can cause variceal bleeding. The use of vasoactive agents such as octreotide is currently limited to acute bleeding episodes. Current strategies to reduce recurrent bleeding events include non-selective beta blockers, treatment of underlying disease including management of risk factors, and periodic endoscopic therapy. There is limited literature on the use of subcutaneous octreotide in the long-term management of recurrent variceal bleeding. CASE: We present a 55-year-old male with progressive non-cirrhotic portal hypertension on the basis of a portal vein thrombus with extensive thrombosis leading to significant portal hypertension and episodic acute variceal bleeding over the course of 15 years. Progression of varices throughout the gastrointestinal tract led to more severe bleeding with requirement for massive transfusion protocols. He was deemed not suitable for shunting procedures or transplantation due to increased bleeding episodes and development of ascites. RESULTS: Following commencement of twice-daily subcutaneous octreotide, no further clinically significant bleeding events occurred. He remains stable more than 3 years on from therapy. CONCLUSIONS: This case demonstrates an observed reduction in clinically significant bleeding and red cell transfusion requirements in a non-cirrhotic portal hypertension patient on daily octreotide. Further larger-scale, randomized controlled studies are required to investigate this observation.