Role of Somatostatin and Its Analogues in Gastrointestinal Fistulas, Ascites and Pancreatic Pseudocysts

Abstract

Naturally occurring somatostatin and, even more so, its analogue, octreotide, by virtue of its greater manageability, are used extensively today in various pancreatic and gastrointestinal disorders, where their potent secretion-inhibiting capacity is exploited. In a number of conditions such as pancreatic fistulas the beneficial efficacy of the hormone is now definitely established both for therapeutic and for prophylactic purposes, whereas, in the other disease areas analyzed here, its use appears to be as an adjuvant to more specific and more radical procedures. Future clarification as to indications, dosage regimens and treatment times may reveal more strictly curative uses of octreotide in its own right, though, even as things stand at present, its efficacy as a complementary measure is so self-evident as to prompt its inclusion in treatment schedules both for enterocutaneous fistulas and for ascites and pancreatic pseudocysts.

In vivo Octreotide Administration Acutely Reduces Exocrine Granule Size in the Human Pancreas

“…Further, octreotide has been successfully used in the treatment of pancreatic fistulae [15,16]. Moreover, a recent prospective trial of perioperative treatment with octreotide showed that this somatostatin analogue has a potential in reducing the incidence of technical complications after pancreatic transplantation [17].…”

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

“…Alongside the historical therapeutic measures (such as adequate drainage, skin protection, fasting and waterelectrolyte control [3]), the current mainstays of specific treatment are pancreatic rest [3,4,5,6,7,8] and inhibition of exocrine secretion [7,8,9,10,11,12,13,14], to which have recently been added high-dose pancreatic extracts [15] and endoscopic treatment with stents [16].…”

“…Given the current state of our knowledge, however, pancreatic rest and inhibition of pancreatic exocrine secretion remain the linch-pins of treatment and are achieved thanks to the use of total parenteral nutrition [4,5,6] and naturally occurring or synthetic somatostatin [8,9,10,11,12,13,14,17], respectively. These measures have proved to be the best currently available to the clinician, since they are capable not so much of drastically increasing fistula healing rates as of significantly reducing external pancreatic fistula closure times with a consequent saving in economic terms [17], amongst other things as a result of the possibility of treating the patient at home [12].…”