Somatostatin Analogues and Pancreatic Fistulas

Abstract

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.

The endoscopic management of pancreatic fistulas

“…There are a variety of approaches available for the therapy of pancreatic fistulas, including conservative treatments with prolonged pancreatic rest (no oral intake with total parenteral nutrition and octreotide administration) and surgery [2,11,12]. The role of therapeutic endoscopy in the treatment of pancreatic diseases has been expanding within the past decade [3,4,8,9,14].…”

Somatostatin for Upper Gastrointestinal Hemorrhage and Pancreatic Surgery

“…In our University Hospital, Roncoroni et al [118] first showed that intravenous infusion of the native somatostatin to a patient with pancreatic cutaneous fistula reduces fistula output by 80%. After this report, numerous studies [117,119] have shown the ability of somatostatin and its analogs to almost completely block (in association with TPN) exocrine pancreatic secretion, thus leading to rapid closure of the fistula.…”

Traumatic pancreatic fistula with sinistral portal hypertension: Surgical management

“…Initial pancreatic injury is difficult to diagnose as the gland is embedded by a retroperitoneal hematoma [5] . Low output fistula from a partial duct transection can be successfully managed by conservative treatment (total parental nutrition and octreotide) [7,8] and endoscopic stenting [9,10] . However, these lengthy and costly conservative treatments proved unsuccessful in our patient with complete duct abruption and high output fistula.…”