Effect of short-term octreotide therapy and total parenteral nutrition on the development of biliary sludge and lithiasis.
OBJECTIVE
Both total parenteral nutrition and long-term octreotide treatment (> 2 months) may induce biliary sludge and lithiasis. However, the lithogenic capacity of the combination of the two treatments in the short-term is unknown. This study was undertaken to evaluate the lithogenic capacity of short-term octreotide treatment (< 1 month) in patients with acute pancreatitis who are also receiving total parenteral nutrition, and to determine the evolution of patients who develop biliary sludge and/or lithiasis.


METHODS
Thirty patients with acute pancreatitis were studied (21 males, 9 females; average age: 38). All patients received total parenteral nutrition and analgesics. In a double-blind random manner, 15 patients were treated with a continuous subcutaneous administration of octreotide (200 micrograms/8 h) and a further 15 patients received placebo. Biliary sludge and/or lithiasis were examined by ultrasonography. An echographic examination of the gallbladder was performed every seven days while the patients were in hospital. They were followed up every month, when another ultrasound of the gallbladder was carried out.


RESULTS
Sixteen patients (53%) developed sludge: ten (67%) from the octreotide group and six (33%) from the placebo group (P = 0.29). Two of the patients from the octreotide group had microlithiasis (P = 0.34) and a cholecystectomy was required. In the other 14 patients, sludge had disappeared by the time of the check-up performed one month after discharge.


CONCLUSIONS
Short-term octreotide treatment does not increase the risk of developing biliary sludge and/or lithiasis in patients also receiving total parenteral nutrition. Biliary sludge formed during total parenteral nutrition and short-term octreotide therapy may disappear when patients begin oral intake. Therefore, preventive measures are not required.
Baudet
Salvador
S
Digestive Disease Research Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Medina
Carlos
C
Vilaseca
Jaime
J
Guarner
Luisa
L
Sureda
Delia
D
Andreu
Jordi
J
Malagelada
Juan-Ramon
JR
D000208:Acute Disease; D000328:Adult; D002769:Cholelithiasis / Q000209:etiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D015282:Octreotide / Q000008:administration & dosage / Q000009:adverse effects*; D010195:Pancreatitis / Q000628:therapy; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011446:Prospective Studies
D015282:Octreotide