Effect of somatostatin on the sphincter of Oddi in patients with acute non-biliary pancreatitis

Abstract

Background-Somatostatin has been used to prevent pancreatitis after endoscopic retrograde cholangiopancreatography but its eVect on acute non-biliary pancreatitis is still unclear. Aim-The purpose of this study was to evaluate the function of the sphincter of Oddi (SO) and the eVect of somatostatin on patients with non-biliary pancreatitis. Methods-Twenty patients (18 males, two females) with acute pancreatitis (alcoholic 18, idiopathic two) received SO manometry within one week after admission. After baseline measurement, a bolus dose of somatostatin (Stilamin, Serono) 250 µg was infused slowly, and SO manometry was repeated after five minutes. Continuous infusion of somatostatin 250 µg/h was given for 12 hours after SO manometry. Serum amylase, lipase, glucose, and C reactive protein (CRP) levels were examined before and after somatostatin infusion. Results-SO manometry was unsuccessful in six patients due to contracted sphincter. In the remaining 14 patients, high SO basal pressure (SOBP >40 mm Hg) was found in seven patients. After somatostatin infusion, mean SOBP decreased from 48.8 (29) to 31.9 (22) mm Hg (p<0.01). One patient had a paradoxical reaction to somatostatin (SOBP increased from 30 to 50 mm Hg) while the other 13 patients had a fall in SOBP after somatostatin. One patient developed abdominal pain with a serum amylase level of 2516 IU/l after SO manometry. No other side eVects or changes in amylase, lipase, glucose, or CRP levels were observed in the other 19 patients after SO manometry and somatostatin infusion. Discussion-Sphincter of Oddi dysfunction is common in patients with acute non-biliary pancreatitis and in most cases somatostatin can relax the sphincter. (Gut 2001;49:843-846) Keywords: acute alcoholic pancreatitis; sphincter of Oddi; somatostatin Gall stone disease, alcohol abuse, and sphincter of Oddi (SO) dysfunction are the common causes of acute pancreatitis.1 2 The action of alcohol on the SO is still controversial. According to some studies, alcohol induces SO relaxation 3 4 but in another human study local instillation of alcohol into the duodenum resulted in an increase in SO motility.5 High SO basal pressure (SOBP) has been found in up to 89% of patients with idiopathic recurrent pancreatitis. [6][7][8] Both natural somatostatin and its synthetic long acting analogue (octreotide) are potent inhibitors of pancreatic enzyme secretions but their eVect on the diseased pancreas is still unclear.9-12 Previous studies have shown that somatostatin can relax the SO allowing free drainage of pancreatic secretions into the duodenum. 13 14 In a recent metaanalysis, somatostatin was found to be more cost eVective than other agents in the prevention of pancreatic injury after endoscopic retrograde cholangiopancreatography. 16However, the action of somatostatin on the SO during the acute stage of pancreatitis is unclear.

Systemic Distribution of Somatostatin Receptor Subtypes in Human: An Immunohistochemical Study

“…Results of these findings in islet cells of human pancreas were consistent with previously reported studies [8,10]. Octreotide generally delivers a good clinical outcome for patients with pancreatitis or prevents pancreatitis after intervention to pancreatic duct in those patients [41][42][43][44], but its mechanism was not well characterized. The results of our present study suspected that octreotide action through sstr4 and sstr5 may play important roles in the regulation of pancreatic juice secretion in acinar cells of pancreas.…”

The Prophylactic Effect of Somatostatin on Post-Therapeutic Endoscopic Retrograde Cholangiopancreatography Pancreatitis

“…23,24 It has been suggested that this is because the 2 agents have a different effect on the Oddi sphincter motilityVoctreotide causes stimulation of the sphincter 25 and somatostatin causes relaxation of the sphincter. 16 Octreotide, being a smaller molecule, may also have a variable affinity for the different somatostatin receptor subtypes, and this may be an additional explanation for the different effects the agents have on the Oddi sphincter. 25,26 It should be noted that high-quality magnetic resonance cholangiopancreatography is a substitute for diagnostic ERCP, 27 and the main use of ERCP is thus increasingly being indicated for therapeutic purposes.…”

Successful Management of a Proximal Pancreatic Duct Fistula Following Pancreatic Transplantation

“…Injection was performed cautiously to avoid filling the pancreatic duct. Peri-interventionally the patient received octreotide in order to reduce exocrine function [22][23][24][25]. By this approach we were able to salvage the pancreas graft.…”