title: Octreotide for treatment of postoperative alimentary tract fistulas.
abstract: Eighteen patients with postoperative fistulas of the gastrointestinal tract were treated with the somatostatin analog octreotide between November 1989 and November 1992. Fourteen patients had enterocutaneous fistulas: seven from the duodenum and seven from the ileum. Another three patients had pancreatic fistulas, and one patient had a biliary fistula. Within 24 hours of octreotide treatment, a mean reduction of 52% in the intestinal fistulas' output, 40% in the pancreatic fistulas, and 30% in the biliary fistula was noted. In the intestinal fistulas group the closure rate was 72% after a mean of 11 days. Early closure (mean 6 days) was achieved in all three pancreatic fistulas. In the patient with the biliary fistula a 30% reduction was observed twice following the administration of octreotide, and an increase occurred when it was withheld. The reduction rate of the secretions in high-output intestinal fistulas (> 500 ml/day) was higher than in the low-output fistulas (63 +/- 8% versus 39 +/- 4%, p < 0.05). Fistula output and the initial response to octreotide treatment had no value in predicting spontaneous healing. In conclusion, octreotide is a valuable tool for the conservative treatment of fistulas of the digestive tract. It is especially valuable for management of high-output enteric fistulas and pancreatic fistulas.
authors.affiliation: Department of Surgery A, Meir Hospital, Kfar Saba, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Paran
authors.forename: D
authors.initials: D
authors.lastname: Neufeld
authors.forename: O
authors.initials: O
authors.lastname: Kaplan
authors.forename: J
authors.initials: J
authors.lastname: Klausner
authors.forename: U
authors.initials: U
authors.lastname: Freund
mesh_terms: D000900:Anti-Bacterial Agents; D003110:Colonic Neoplasms / Q000601:surgery; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D007279:Injections, Subcutaneous; D007412:Intestinal Fistula / Q000188:drug therapy* / Q000209:etiology; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D013274:Stomach Neoplasms / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D015282:Octreotide