Somatostatin Analogues for the Treatment of Enterocutaneous Fistulas: A Systematic Review and Meta‐analysis

Coughlin, Shaun; Roth, L; Lurati, Giovanna; Faulhaber, Markus

doi:10.1007/s00268-012-1494-3

Cited by 36 publications

(16 citation statements)

References 22 publications

(51 reference statements)

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“…Proton pump inhibitors and sucralfate were prescribed to decrease the acidity of the efﬂuent and to potentially limit corrosive effects on skin. To control bilio-pancreatic output it was placed a catheter through the major duodenal papilla and it was administered octreotide, a long-acting somatostatin analog, which decrease ﬁstula output by inhibiting secretion of various gastrointestinal hormones [ 16 , 17 ]. Skin barriers, adhesives (liquid, aerosol, and discs), dressings, and pouches were applied daily for protecting and maintain skin integrity.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of postoperative laparostomy and pyloroduodenostomy—Case report

Bernardes¹,

Melo²,

Ferraz

2018

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of postoperative laparostomy and pyloroduodenostomy—Case report

Bernardes¹,

Melo²,

Ferraz

2018

International Journal of Surgery Case Reports

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“…Most studies on somatostatin (analogues) were performed to assess the effect on fistula closure rather than output reduction. Three recent systematic reviews and meta‐analyses on somatostatin (analogues) and ECF showed a potential benefit in time to closure and closure rate. However, this effect is most likely to be found in simple low‐output fistulas.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: pharmacotherapy for high‐output enterostomies or enteral fistulas

Vries

Reeskamp

Ruler

et al. 2017

Aliment Pharmacol Ther

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“…[41][42][43][44][45][46][47][48][49] Two recent meta-analyses summarize their results: somatostatin analogues and somatostatin do not improve mortality, but they seem to decrease fistula output, allow faster spontaneous closure, and decrease hospital stay. 50,51 The longest follow-up interval in studies is 90 days. 41 Somatostatin analogues versus control resulted in greater success of spontaneous fistula closure (relative risk [RR] 1.36) and shorter time interval to closure.…”

Section: Medical Management Of Fistula Outputmentioning

confidence: 99%

Enterocutaneous Fistula: Proven Strategies and Updates

Gribovskaja‐Rupp

Melton

2016

Clinics in Colon and Rectal Surgery

111

129

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An enterocutaneous fistula (ECF) is an aberrant connection between the intra-abdominal gastrointestinal (GI) tract and skin/wound. Because of differences in management and significant preponderance of small intestinal and colonic fistulae, fistulae originating in the rectum, upper GI tract, or pancreas will not be discussed in this article.There are several ways in which ECF has been classified, including by output, etiology, and source.1-3 Most often, a high-output ECF is characterized as one with >500 mL/24 hours, low output <200 mL/24 hours, and a moderate output fistula between 200 and 500 mL/24 hours. While the great majority of ECFs are iatrogenic (75-85%), between 15 and 25% occur spontaneously. 3 Common causes of iatrogenic ECF are trauma; operations for malignancy, associated with extensive adhesiolysis, or in the setting of inflammatory bowel disease (IBD); and trauma. 1 With respect to postoperative small bowel fistulae, about half are from an anastomotic leak, with the other half occurring from inadvertent injury to the small bowel during dissection.3 Spontaneous fistulae occur from IBD (most common), malignancy, appendicitis, diverticulitis, radiation, tuberculosis/actinomycosis, and ischemia. 3Organ of origin is another classification used for ECF and is useful as well in the consideration of management options: type I (abdominal, esophageal, gastroduodenal), type II (small bowel), type III (large bowel), and type IV (enteroatmospheric, regardless of origin). 2Closure rates without operative intervention in the era of advanced wound care and parenteral nutrition (PN) vary considerably in reports 19 to 92%, 4,5 with most studies demonstrating closure rates in the 20 to 30% range. 5-11With historical wound care measures, 90% of spontaneous closure occurred in the first month after sepsis resolution, with an additional 10% closing in the second month, and none closing spontaneously after 2 months. 10 With vacuum assisted closure (VAC) and other negative pressure wound therapies (NPWT) therapy, there are case reports of fistulae closure well into the second and third month. ►Table 1 cites favorable and unfavorable prognostic factors for spontaneous fistula closure. 3,4,6,8,[12][13][14] Mortality rates in different series for patients with ECF are also markedly variable in distribution (5.5-33%), 4,7,15 with most deaths attributable to sepsis, malnutrition, and fluid/ electrolyte disturbances. 4,6,7,15,16 Factors that are predictive of high mortality are infectious and noninfectious complications, high-output fistula, 1,8,15,17 and age. 18 Cost of fistula care is significant and typically more than $500,000. 19 Approach to Enterocutaneous FistulaA common acronym used to describe ECF care protocol is "SNAP," which stands for management of skin and sepsis, nutrition, definition of fistula anatomy, and proposing a Keywords ► enterocutaneous fistula ► enteroatmospheric fistula ► spontaneous closure ► mortality ► timeline AbstractManagement of enterocutaneous fistula represents one of the most protracted and...

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Somatostatin Analogues for the Treatment of Enterocutaneous Fistulas: A Systematic Review and Meta‐analysis

Cited by 36 publications

References 22 publications

Surgical treatment of postoperative laparostomy and pyloroduodenostomy—Case report

Surgical treatment of postoperative laparostomy and pyloroduodenostomy—Case report

Systematic review: pharmacotherapy for high‐output enterostomies or enteral fistulas

Enterocutaneous Fistula: Proven Strategies and Updates

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