Lack of difference among vasoconstrictors: Similar effectiveness or similar ineffectiveness?

I read with interest the article by Seo et al. regarding the use of vasoconstrictors in the control of acute gastroesophageal variceal hemorrhage.1 The authors found that hemostatic effects were similar between terlipressin, somatostatin, and octreotide as adjuvants to endoscopic therapy in patients with acute gastroesophageal variceal hemorrhage. However, some results appeared to be contradictory to previous studies and need further clarification.

Current guidelines recommend that vasoactive drugs should be started as soon as possible before endoscopy in suspected variceal bleeding.2, 3 Previous trials have shown that the use of vasoconstrictors could decrease the incidence of active variceal bleeding at endoscopy from around 46%-50% to 16%-31%.4-6 In the Seo et al. trial, the institution of any kind of vasoactive drug before endoscopy was noted to encounter an appreciably high incidence of active variceal bleeding, i.e., around 43%-44% at endoscopy. The 5-day treatment success was around 83%-86% in each treatment group. Though not a head-to-head comparison, these figures were apparently lower than the hemostatic rate of 92%-97% achieved by other scholars with banding ligation alone or in conjunction with vasoconstrictors.5-8 Thus, based on the current study, it is dubious that terlipressin, somatostatin, and octreotide as an adjuvant therapy to banding ligation in the control of acute variceal bleeding would be of similar effectiveness or similar ineffectiveness.