Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas.
OBJECTIVE
Gastrointestinal and pancreatic fistulas are characterized as serious complications following abdominal surgery, with a reported incidence of up to 27% and 46%, respectively. Fistula formation results in prolonged hospitalization, increased morbidity/mortality and increased treatment costs. Conservative and surgical approaches are both employed in the management of these fistulas. The purpose of the present study was to assess, evaluate and compare the potential clinical benefit and cost effectiveness of pharmacotherapy (somatostatin versus its analogue octreotide) versus conventional therapy.


METHODS
Fifty-one patients with gastrointestinal or pancreatic fistulas were randomized to three treatment groups: 19 patients received 6000 IU/day of somatostatin intravenously, 17 received 100 microg of octreotide three times daily subcutaneously and 15 patients received only standard medical treatment.


RESULTS
The fistula closure rate was 84% in the somatostatin group, 65% in the octreotide group and 27% in the control group. These differences were of statistical significance (P=0.007). Overall mortality rate was less than 5% and statistically significant differences in mortality among the three groups could not be established. Overall, treatment with somatostatin and octreotide was more cost effective than conventional therapy (control group), and somatostatin was more cost effective than octreotide. The average hospital stay was 21.6 days, 27.0 and 31.5 days for the somatostatin, octreotide and control groups, respectively.


CONCLUSIONS
Data suggest that pharmacotherapy reduces the costs involved in fistula management (by reducing hospitalization) and also offers increased spontaneous closure rate. Further prospective studies focusing on the above parameters are needed to demonstrate the clinicoeconomic benefits.
Leandros
Emanuel
E
Hippocration Hospital, Athens Medical School, Athens, Greece.
Antonakis
Pantelis T
PT
Albanopoulos
Konstantinos
K
Dervenis
Chris
C
Konstadoulakis
Manousos M
MM
D000005:Abdomen / Q000601:surgery; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D005747:Gastric Fistula / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007412:Intestinal Fistula / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000191:economics / Q000627:therapeutic use*; D010185:Pancreatic Fistula / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D011183:Postoperative Complications; D013004:Somatostatin / Q000191:economics / Q000627:therapeutic use*
D005765:Gastrointestinal Agents; D013004:Somatostatin; D015282:Octreotide