Drugs Inhibiting Exocrine Pancreatic Section

Pederzoli, Paolo; Falconi, Massimo; Bassi, Claudio; Benetti, L.; Briani, G.

doi:10.1007/978-3-642-77418-8_13

Cited by 3 publications

(4 citation statements)

References 43 publications

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“…Such imbalances, however, are rarely present in cases of low-output fistulas and when the patient is able to maintain oral nutrition. The latter, however, is a major stimulus to pancreatic secretion [4,5,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Alongside the historical therapeutic measures (such as adequate drainage, skin protection, fasting and waterelectrolyte control [3]), the current mainstays of specific treatment are pancreatic rest [3,4,5,6,7,8] and inhibition of exocrine secretion [7,8,9,10,11,12,13,14], to which have recently been added high-dose pancreatic extracts [15] and endoscopic treatment with stents [16].…”

Section: Introductionmentioning

confidence: 99%

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Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience

Bassi¹,

Falconi²,

Salvia³

et al. 2000

Langenbeck's Archives of Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience

Bassi¹,

Falconi²,

Salvia³

et al. 2000

Langenbeck's Archives of Surgery

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“…Its mecha nism of action on the pancreas, mediated by the abovementioned receptors, takesthe form of inhibition of secre tion through interference with the permeability of the pancreatic acinus to calcium ions [3], The hormone, in humans, has proved capable of inhibiting the output of enzymes, bicarbonates and volume after stimulation with secretin and cholecystokinin [4], and may be the ideal drug in the treatment of PFs. In 1982, the theoretical potential of somatostatin received clinical confirmation in several simultaneous studies which reported successes achieved by combining the molecule with TPN [3], In 1986. our own group conducted a retrospective study in 45 patients with pure high-output external PF. Eighteen patients were treated with TPN alone, 12 with TPN plus glucagon, 7 with TPN plus calcitonin and 8 with TPN plus naturally occurring somatostatin at a dose of 250 pg/h by continuous intravenous (i.v.)…”

Section: Specific Treatment -Pancreatic Rest and Inhibitionmentioning

confidence: 99%

“…The basic difference lies in the fact that TPN and, to a lesser extent, enteral nutrition are mild inhibitors, but good pancreatic resting agents and excel lent calorie-protein reintegrators, while somatostatin compounds are potent inhibitors of secretion, but are able to act only indirectly on the nutritional calorie-protein balance by reducing the losses. The complementary na ture of their actions has suggested their use in association [2,3].…”

Section: Specific Treatment -Pancreatic Rest and Inhibitionmentioning

confidence: 99%

Somatostatin Analogues and Pancreatic Fistulas

Bassi¹,

Falconi²,

Caldiron³

et al. 1996

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Consideration is given to the characterisation of pancreatic fistulas (PFs), the rationale for their treatment, and supportive and specific treatment measures. Choice of treatment should be based not only on the percentage of closures achieved, but also on their time and cost. The combined use of parenteral nutrition (TPN) and somatostatin inhibits pancreatic secretion well; no therapy can inhibit it completely. Presumptive use of octreotide, a subcutaneous formulation of somatostatin, in patients undergoing elective pancreatic surgery, reduced postoperative complications, mainly PFs, in about 500 patients in two controlled double-blind clinical studies, confirming the use of octreotide both in prophylaxis and treatment. Octreotide has been tested on outpatients after a brief hospitalisation period, at a dose of 100 mg three times a day. Home treatment does not involve co-administration of TPN, thus lowering not only costs but also risks. Optimal doses and the types of fistula amenable to this therapy need to be established and we only use out-patient treatment for chronic low-output fistulas.

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External Pancreatic Fistula as a Sequel to Management of Acute Severe Necrotizing Pancreatitis

et al. 2005

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Background/Aims: External pancreatic fistula (EPF) is a common sequel to surgical or percutaneous intervention for infective complications of acute severe pancreatitis. The present study was aimed at studying the clinical profile, course and outcome of patients with EPF following surgical or percutaneous management of these infective complications. Methods: A retrospective analysis of clinical data of patients with EPF following intervention (surgical or percutaneous) for acute severe pancreatitis managed between January 1989 and April 2002 recorded on a prospective database was done. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) that could predict early closure of fistula was performed. Results: Of 210 patients with acute severe pancreatitis, 43 (20%) patients developed EPF (mean age 38 (range 16–78) years, M:F ratio 5:1) following intervention for infected pancreatic necrosis (n = 23) and pancreatic abscess (n = 20) and constituted the study group. The fistula output was categorized as low (<200 ml), moderate (200–500 ml) and high (>500 ml) in 29 (67%), 11 (26%) and 3 (7%) patients, respectively. Fifteen patients (35%) had morbidity in the form of abscess (n = 5), bleeding (n = 1), pseudoaneurysm (n = 2) and fever with no other focus of infection (n = 7). Spontaneous closure of the fistula occurred in 38 (88%) patients. The average time to closure of fistula was 109 ± 26 (median 70) days. Fistula closed after intervention in 5 patients (2 after endoscopic papillotomy, 1 after fistulojejunostomy and 2 after downsizing the drains). Of the 38 patients with spontaneous closure, 9 (24%) patients developed a pseudocyst after a mean interval of 123 days of which 7 underwent surgical drainage of the cyst. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) failed to identify any factors that could predict early closure of fistula. Conclusions: EPF is a common sequel following intervention in acute severe pancreatitis. The majority of these are low output fistulae and close spontaneously with conservative management. One-fourth of patients with spontaneous closure develop a pseudocyst as a sequel, requiring surgical management.

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Drugs Inhibiting Exocrine Pancreatic Section

Cited by 3 publications

References 43 publications

Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience

Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience

Somatostatin Analogues and Pancreatic Fistulas

External Pancreatic Fistula as a Sequel to Management of Acute Severe Necrotizing Pancreatitis

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