title: Somatostatin analogues do not prevent carcinoid crisis.
abstract: BACKGROUND
  Carcinoid crisis is a life-threatening syndrome of neuroendocrine tumors (NETs) characterized by dramatic blood pressure fluctuation, arrhythmias, and bronchospasm. In the era of booming anti-tumor therapeutics, this has become more important since associated stresses can trigger carcinoid crisis. Somatostatin analogues (SSTA) have been recommended for prophylactic administration before intervention procedures for functioning NETs. However, the efficacy is still controversial. The aim of this article is to review efficacy of SSTA for preventing carcinoid crisis.
  
  
  METHODS
  PubMed, Cochrane Controlled trials Register, and EMBASE were searched using 'carcinoid crisis' as a search term combining terms with 'somatostatin'; 'octreotide'; 'lanreotide' and 'pasireotide' until December 2013.
  
  
  RESULTS
  Twenty-eight articles were retrieved with a total of fifty-three unique patients identified for carcinoid crisis. The most common primary sites of NETs were the small intestine and respiratory tract. The triggering factors for carcinoid crisis included anesthesia/ surgery (63.5%), interventional therapy (11.5%), radionuclide therapy (9.6%), examination (7.7%), medication (3.8%), biopsy (2%) and spontaneous (2%). No randomized controlled trials (RCTs) were identified and two case-control studies were included to assess the efficacy of SSTA for preventing carcinoid crisis by meta-analysis. The overall pooled risk of perioperative carcinoid crisis was similar despite the prophylactic administration of SSTA (OR 0.44, 95% CI: 0.14 to 1.35, p=0.15).
  
  
  CONCLUSIONS
  SSTA was not helpful for preventing carcinoid crisis based on a meta-analysis of retrospective studies. Attentive monitoring and careful intervention are essential. Future studies with better quality are needed to clarify any effect of SSTA for preventing carcinoid crisis.
authors.affiliation: Department opf Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China E-mail : shcqcdmed@163.com.
authors.forename: Lin-Jie
authors.initials: LJ
authors.lastname: Guo
authors.forename: Cheng-Wei
authors.initials: CW
authors.lastname: Tang
mesh_terms: D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D008303:Malignant Carcinoid Syndrome / Q000188:drug therapy* / Q000517:prevention & control*; D018358:Neuroendocrine Tumors / Q000188:drug therapy / Q000517:prevention & control; D015282:Octreotide / Q000627:therapeutic use*; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D012137:Respiratory System / Q000473:pathology; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin; C517782:pasireotide; D015282:Octreotide