Effect of octreotide on gastrostomy, duodenostomy, and cholecystostomy effluents: a physiologic study of fluid and electrolyte balance.
OBJECTIVE
Octreotide, a somatostatin analog, reduces stool and fistula outputs by a mechanism that is not completely understood. Our aim was to study its effect on gastrostomy, duodenostomy, and cholecystostomy effluents in a patient with colorectal cancer.


METHODS
Effluents of gastrostomy, duodenostomy, and cholecystostomy were collected in three separate shifts over 24-h periods beginning 3 days before octreotide therapy and continuing for 15 treatment days. Fifty-four samples were tested for volume, pH, acid, and bicarbonate production, and biochemical profiles.


RESULTS
A positive fluid balance was achieved immediately with octreotide therapy. Significant decreases in gastrostomy and duodenostomy outputs and in gastric acid production were observed (1433.33 +/- 33.33 ml/24 h to 535.71 +/- 55.31 ml/24 h,p < 0.0001; 2066.67 +/- 66.67 ml/24 h to 247.14 +/- 36.04 ml/24 h, p < 0.0001; and 67.50 +/- 3.20 mEq/h to 13.00 +/- 1.50 mEq/h, p < 0.0001; respectively). Gastrostomy tachyphylaxis was observed after 6 days of treatment. Remarkable dose-dependent increases were found in cholesterol and bilirubin concentrations in the cholecystostomy effluent.


CONCLUSIONS
Octreotide's primary effect is a decrease in gastric and pancreatic secretions. The increased concentrations of cholesterol and bilirubin may explain the occurrence of gallstones in patients treated with octreotide.
Niv
Y
Y
The Department of Gastroenterology, Beilinson Campus, Rabin Medical Center, Petah-Tikva, Israel.
Charash
B
B
Sperber
A D
AD
Oren
M
M
D000230:Adenocarcinoma / Q000503:physiopathology / Q000601:surgery; D000368:Aged; D002767:Cholecystostomy; D003110:Colonic Neoplasms / Q000503:physiopathology / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D004385:Duodenostomy; D005122:Exudates and Transudates / Q000187:drug effects* / Q000378:metabolism; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000494:pharmacology*; D005774:Gastrostomy; D006801:Humans; D015282:Octreotide / Q000008:administration & dosage / Q000494:pharmacology*; D011184:Postoperative Period; D012086:Reoperation; D013997:Time Factors
D005765:Gastrointestinal Agents; D015282:Octreotide