Treatment of 27 Postoperative Enterocutaneous Fistulas with the Long Half-life Somatostatin Analogue SMS 201–995

Abstract

Twenty-seven patients with postoperative enterocutaneous fistulas were treated with parenteral nutrition and SMS 201-995 (100 micrograms/8 hours, subcutaneously), a long half-life somatostatin analogue. At the time SMS 201-995 was started, 11 patients had low output fistulas (less than 1000 ml/48 hours), 11 patients had high output fistulas (above 1000 ml/48 hours), and 5 patients had fistulas sitting in large abdominal wall defects. Within 24 hours of treatment, a mean reduction of 55% of the fistula output was observed. Fistula site or output before treatment had no influence on the magnitude of output reduction. Spontaneous closure was achieved in 77% of the patients after a mean of 5.8 +/- 2.7 days of treatment with this drug. Two patients died (7.4%). Pain at the injection site was referred by 15% of the patients but no other side effects were observed. Glucose intolerance was not observed. SMS 201-995 has been shown to be very useful in the conservative treatment of enterocutaneous fistulas because of its ability to rapidly reduce fistula output and accelerate spontaneous closure.

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

“…Octreotide, which is a somatostatin 14 analogue, has been used to aid ECF closure along with standard conservative treatment [8,15] . However, this has been controversial with some suggesting that it has no benefits [16] , especially in complex fistulae [17] .…”

Management of patients with a short bowel

“…The effect of octreotide is maintained in the long-term [107,109,110,112,114] . Somatostatin and octreotide both reduce the output from a high fistula and appear to accelerate the rate of spontaneous closure [115,116] .…”