Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula

Abstract

Somatostatin and octreotide both enhance closure of gastrointestinal fistulas. The present trial was undertaken to test whether early combined treatment with parenteral nutrition and octreotide 100 micrograms every 8 h by subcutaneous injection had a beneficial effect compared with parenteral nutrition plus placebo. Thirty-one patients with post-operative gastrointestinal or pancreatic fistula were randomly assigned to receive parenteral nutrition plus octreotide (14 patients) or placebo (17) within 8 days of fistula onset. The percentage reduction in output and rate of spontaneous closure within 20 days were analysed. Mean(s.d.) reduction in output was similar after octreotide and placebo at 24 h (66(43) versus 68(47) per cent, P = 0.9), 48 h (60(46) versus 57(43) per cent, P = 0.8) and 72 h (62(50) versus 66(49) per cent, P = 0.9) after starting the combined treatment. Closure within 20 days was observed in eight of 14 fistulas in patients given octreotide and in six of 17 in those receiving placebo (P = 0.4). Administration of octreotide, within 8 days of fistula onset, associated with parenteral nutrition does not significantly increase the spontaneous fistula closure rate compared with parenteral nutrition plus placebo.

Enterocutaneous Fistulas: A Look at Causes and Management

“…The literature confirms that they are associated with decreased output and a decreased time to closure in highly favorable fistulas that are most likely destined to close without surgery [2,11,42], but not necessarily increased non-operative closure rate [43][44][45][46]. Some studies document utility in higher output fistulas to help minimize fluid and electrolyte loss and protect the skin.…”

Management of enterocutaneous fistulae: A 10 years experience

“…However, this has been controversial with some suggesting that it has no benefits [16] , especially in complex fistulae [17] . We used Octreotide in 21 of the patients treated conservatively.…”

Complications of Pancreatic Cancer Resection

“…High dependency monitoring may or may not be necessary, but usually not in the absence of other complications. The value of octreotide in the treatment of established pancreatic fistulae is not clear with studies showing conflicting data [69, 70, 71, 72, 73]. Whilst there may be a limited role for octreotide in the management of pancreatic fistula, there may be more to be gained in the presence of an intestinal fistula (uncommon in pancreatic surgery).…”