Effects of Intra-Arterial Octreotide on Pancreatic Texture: A Randomized Controlled Trial

Abstract

Background and Aims:Octreotide is suggested to harden the pancreas, thus facilitating the construction of a pancreatic anastomosis and lowering the risk of postoperative fistula. We tested the hypothesis that intra-arterial application of octreotide in the gastroduodenal artery during pancreatectomy may increase pancreatic hardness.Material and Methods: A single-center, prospective, double-blinded, randomized controlled trial with parallel assignment was conducted. Patients planned for a pancreatoduodenectomy or a total pancreatectomy, who had a palpatory and durometer proven (<40 Shore units) soft pancreas, were assigned to receive intraoperatively either 5 mL 500µg octreotide or 5 mL 0.9% saline solution as a bolus injection in the gastroduodenal artery. Pancreatic hardness was measured before, early, and late after intervention. The investigator performing the durometer measurements and pathologist were masked to group assignment. The primary outcome was increased pancreatic hardness. Analysis was by intention to treat. This trial is registered at http://www.clinicaltrials.gov (ID NCT01400100).Results: A total of 12 patients received octreotide and 13 received saline solution. Pancreatic hardness marginally increased in the octreotide group: 0.67 ± 2.3 Shore units, whereas it decreased in the control group: −2.15 ± 2.7 Shore units. The difference was statistically significant, p = 0.029 (95% confidence interval = −4.87 to −0.77). Histology did not find any correlate for this clinically irrelevant hardening effect.Conclusions: A single bolus application of octreotide did not deliver a clinically relevant increase in pancreatic hardness. Future studies on the hardening effect of octreotide should employ repeated or continuous preoperative administration of this drug.

Efficacy of the prophylactic use of octreotide for the prevention of complications after pancreatic resection

“…The function of octreotide in reducing fistula formation and promoting fistula closure is associated with 2 primary mechanisms: the inhibition of exocrine pancreatic secretion and the hardening of pancreatic tissue to facilitate safer anastomosis. [41] A meta-analysis performed by Alghamdi et al [42] summarized 7 RCTs and revealed that octreotide is associated with a significant reduction in the incidence of PF after pancreatic surgery, and no significant difference in postoperative mortality was observed. The results of the subgroup analysis according to the type of study design were consistent with our findings.…”

Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

“…51 Administration of intraarterial octreotide did not result in any clinically relevant effect on tissue hardness. 52 One study performed ultrasound elastography intraoperatively in order to quantify the texture of the gland. 53 Others have suggested preoperative CT to calculate pancreatic remnant volume and duct width to offer useful information about the risk of POPF.…”

“…Intra-arterial injection of octreotide did not affect gland texture in a small RCT. 52 Pasireotide is a relative new somatostatin-analogue used in the treatment of Cushing syndrome with a 40-times higher affinity to the somatostatin-5 receptor compared to other somatostatinanalogues. An RCT on pasireotide 61 demonstrated a significant reduction in clinically relevant fistulas, leaks and abcesses (relative risk, 0.44; 95% confidence interval [CI], 0.24-0.78; P = 0.006).…”

Quantitative assessment of liver fibrosis using shore durometer

“…The spring measuring force of this device was converted to shore units (SU), an arbitrary parameter of hardness. In the case of pancreas, measuring the hardness of pancreas parenchyma using a shore durometer has been reported [ 1 2 3 4 ].…”