Octreotide for pancreatic fistula – pro

docs with patient

The principal effects of octreotide include inhibition of growth hormone (GH), glucagon, and insulin. However, there are other effects that have been attemtped to be exploited to therapeutic ends, including to help heal pancreatic and gastreointeistinal fistulas.  Among themare reduction of splanchnic blood flow, and inhibition of release of several gastrointestinal hormones, including serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide.

Graham et al. conducted a prospective study of prophylactic long-acting octreotide to prevent postoperative pancreatic fistula (POPF) in high-risk patients undergoing
pancreaticoduodenectomy. The authors concluded that prophylactic use of depot octreotide in high-risk patients does not result in reduced incidence of POPF.

A recent Cochrane review of somatostatin analogues (SSAs) for pancreatic surgery concluded that SSAs reduce perioperative complications but do not reduce perioperative mortality. In those undergoing pancreatic surgery for malignancy, they shorten hospital stay. Further adequately powered trials with low risk of bias are necessary. Based on the current available evidence, somatostatin and its analogues are recommended for routine use in patients undergoing pancreatic resection for malignancy. There is currently no evidence to support their routine use in pancreatic surgeries performed for other indications.

In a meta-analysis by Zeng et al., eight studies were reviewed to evaluate the efficacy of somatostatin and its analogues in the prevention of postoperative complications after
pancreaticoduodenectomy. The use of somatostatin or its analogues did not significantly benefit for reducing the incidence  of pancreatic fistula (odds ratio [OR] 95% confidence interval [CI], 0.64-1.37; p=0.73), total pancreas-specific postoperative complications (OR 95% CI, 0.63-1.42; p=0.79), delayed gastric emptying (OR 95% CI, 0.50-1.78; p=0.86), total complication (OR 95% CI, 0.73-1.70; p=0.61), mortality (OR 95% CI, 0.59-7.72; p=0.97) and length of postoperative hospital stay (weighted mean difference 95% CI, -7.74 to 4.47; p=0.60). The use of somatostatin and its analogues does not significantly reduce postoperative complications after pancreaticoduodenectomy.

Several clinical trials have evaluated the use of octreotide to prevent the development of pancreatic fistula after pancreatic surgery with conflicting recommendations. A recent review on surgicalcreiticalcare.net concluded that : “There is insufficient evidence to conclude that octreotide reduces fistula closure rates or time to closure. Octreotide therapy
may be useful when there is reason to believe that a reduction in fistula output would facilitate patient management. However, its use for the purpose of fistula closure or the use of doses greater than those evaluated in clinical trails cannot be recommended.”

Graham JA, Johnson LB, Haddad N, et al. A prospective study of prophylactic long-acting
octreotide in high-risk patients undergoing pancreatticoduodenectomy. The American Journal of
Surgery. 2011;201(4):481-485.

Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery.
Cochrane Database of Systematic Reviews 2010, Issue 2.

Zeng Q, Zhang Q, Han S, et al. Efficacy of somatostatin and its analogues in prevention of
postoperative complications after pancreaticoduodenectomy: a meta-analysis of randomized
controlled trials. Pancreas. 2008 Jan;36(1):18-25.

GASTROINTESTINAL AND PANCREATIC FISTULAS – http://www.surgicalcriticalcare.net/Guidelines/octreotide%202009.pdf

For Lay version see here

Octreotide fir angiodyslpasia and for angiodysplasis and GI bleeding

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