Prophylactic octreotide and delayed gastric emptying after pancreaticoduodenectomy: results of a prospective randomized double-blinded placebo-controlled trial.
OBJECTIVE
To evaluate the impact of prophylactic octreotide on gastric emptying in patients undergoing pancreaticoduodenectomy. Postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE) are common complications after pancreaticoduodenectomy. Whereas several prospective randomized trials propose the prophylactic use of octreotide to prevent pancreatic fistula formation, somatostatin has, however, been associated with delayed gastric emptying after partial duodenopancreatectomy.


METHODS
In this prospective, randomized, double-blinded, placebo-controlled trial we analyzed the influence of prophylactic octreotide on delayed gastric empting after pancreaticoduodenectomy. Patients were randomized to the placebo group (n=32) and the octreotide group (n=35). Primary endpoint was the incidence of delayed gastric emptying, secondary endpoints included perioperative morbidity other than DGE. DGE was measured by clinical signs, gastric scintigraphy and the hydrogen breath test. Risk factors for DGE other than octreotide were analyzed by univariate and multivariate analyses.


RESULTS
DGE measured by clinical signs was similar between both groups studied ( approximately 20% of the patients). Gastric scintigraphy (T(1/2)) was 76.3+/-15.2 min in the octreotide group and 86.7+/-18.0 min in controls at day 7, respectively. The H(2) breath test was 65.0+/-6.5 min in octreotide treatment group and 67.0+/-5.7 min in controls at day 8. POPF grade C occurred in approximately 3% of the patients, although prophylactic treatment of octreotide did not reduce the incidence of POPF. Multivariate analysis showed that postoperative intraabdominal bleeding and infection were independent risk factors for DGE. Furthermore preoperative biliary stenting reduced postoperative DGE after partial duodenopancreatectomy.


CONCLUSIONS
Prophylactic octreotide has no influence on gastric emptying and does not decrease the incidence of postoperative pancreatic fistula after pancreaticoduodenectomy.
Kollmar
O
O
Department of General, Visceral, Vascular and Pediatric Surgery, Kirrbergerstr, University of Saarland, D-66421 Homburg/Saar, Germany.
Moussavian
M R
MR
Department of General, Visceral, Vascular and Pediatric Surgery, Kirrbergerstr, University of Saarland, D-66421 Homburg/Saar, Germany.
Richter
S
S
Department of General, Visceral, Vascular and Pediatric Surgery, Kirrbergerstr, University of Saarland, D-66421 Homburg/Saar, Germany.
de Roi
P
P
Department of General, Visceral, Vascular and Pediatric Surgery, Kirrbergerstr, University of Saarland, D-66421 Homburg/Saar, Germany.
Maurer
C A
CA
Department of Surgery, Hospital of Liestal, CH-4410 Liestal, Switzerland.
Schilling
M K
MK
Department of General, Visceral, Vascular and Pediatric Surgery, Kirrbergerstr, University of Saarland, D-66421 Homburg/Saar, Germany. Electronic address: martin.schilling@uniklinikum-saarland.de.
D000368:Aged; D004311:Double-Blind Method; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012307:Risk Factors; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D015282:Octreotide