Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience

Bassi, Claudio; Falconi, Massimo; Salvia, Roberto; Caldiron, E.; Butturini, Giovanni; Pederzoli, Paolo

doi:10.1007/s004230050003

Cited by 19 publications

(12 citation statements)

References 13 publications

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“…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).…”

Section: Fistulae Of the Pancreatointestinal Anastomosismentioning

confidence: 96%

Complications of Pancreatic Cancer Resection

et al. 2002

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Pancreatic cancer is a common cause of cancer death in the developed world. Currently, resection is the only chance of long-term survival. The post-operative mortality in nonspecialist centres often exceeds 20% but is around 6% or less in specialist centres. The overall complication rate even in specialist centres is 18–54%. An analysis of eleven large series of pancreatic resections shows an incidence of common complications of 10.4% for fistula, 9.9% for delayed gastric emptying, 4.8% for bleeding, 4.8% for wound infection and 3.8% for intra-abdominal abscess. The median hospital stay is 13–18 days in different series. The re-operation rate varies from 4 to 9% with a mortality rate of 23 to 67%. Major complications are a significant factor in post-operative mortality, especially if they require re-operation. The use of octreotide or somatostatin to prevent complications is supported by several multicentre, double-blind, randomized controlled trials. The best way to improve outcome is to concentrate pancreatic cancer care in regional specialist centres.

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Section: Fistulae Of the Pancreatointestinal Anastomosismentioning

confidence: 96%

Complications of Pancreatic Cancer Resection

et al. 2002

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“…From the literature and the experience of our group, which has always focused particular attention on this issue [26, 27], we conclude that the greatest or lowest risk factor for developing a fistula post-operatively is the definition used!…”

Section: Discussionmentioning

confidence: 99%

“…Our national referral centre for the treatment of pancreatic diseases fits well within this definition. Paying particular attention to definitions and management [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35], in a prospective clinical audit we have verified the mortality and morbidity of 150 consecutive PDs performed in our centre in the last 3 years before the new millennium.…”

Section: Introductionmentioning

confidence: 99%

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

et al. 2001

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Pancreaticoduodenectomy (PD) is still a difficult procedure with significant morbidity. We report 150 consecutive PDs performed during a 3-year period. All the cases have been prospectively evaluated with regard to the surgical outcome. Mortality in this series was 3/150 (2%) with a re-operation rate of 5/150 (3.3%); surgical complications were experienced in 57/150 (38%). The most frequent complications were collections in 25/150 (16.6%) and pancreatic fistulas in 16/150 (10.7%). The majority of these complications were conservatively managed: only one abscess and one fistula due to an anastomotic dehiscence required re-operation. The complication most responsible for mortality was haemorrhage secondary to arterial pseudoaneurysms in patients with severe post-operative pancreatitis. The continued high morbidity of PDs is compensated by the ability to treat complications non-operatively, resulting in a surgical risk that should now be considered medium to low in high volume centres.

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“…With intravenous octreotide, low-volume EPFs (< 100 ml/day) healed after an average of 12 7 days, while high-volume fistulas (> 100 ml/day) required a mean of 28 27 days [3]. A surgical approach was used by Bassi et al, who described 17 patients with EPF who underwent fistulojejunostomy.…”

Section: Discussionmentioning

confidence: 97%

External Pancreatic Fistulas Resistant to Conventional Endoscopic Therapy: Endoscopic Closure With N-Butyl-2-Cyanoacrylate (Glubran 2)

et al. 2004

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External pancreatic fistulas may follow abdominal surgery or injury. While most respond to conservative management or endoscopic intervention, others might require surgery for complete healing. We report four cases of patients with external pancreatic fistulas that failed to respond to conservative management and drainage. N-butyl-2-cyanoacrylate surgical glue (Glubran 2) was directly injected into the fistulous tract. The fistulas closed within 24 hours of the Glubran 2 injection in three cases (75 %). In patients with external pancreatic fistulas that fail to respond to conservative and endoscopic drainage, injection of Glubran 2 directly into the fistulous tract may lead to closure, thus avoiding the need for surgical intervention.

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Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience

Abstract: Octreotide appears useful in the treatment of external pancreatic fistulas. For optimal results to be achieved, there must be no local infection and no mechanical or anatomical obstacles to the free flow of juice.

Cited by 19 publications

References 13 publications

Complications of Pancreatic Cancer Resection

Complications of Pancreatic Cancer Resection

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

External Pancreatic Fistulas Resistant to Conventional Endoscopic Therapy: Endoscopic Closure With N-Butyl-2-Cyanoacrylate (Glubran 2)

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