Treatment of External Gastrointestinal Fistulas by a Combination of Total Parenteral Nutrition and Somatostatin

Costanzo, J. Di; Cano, Noël; Martín, J. M. Álamo; Richieri, J. P.; Mercier, Richard J.; Lafille, C; Lepeuch, D.

doi:10.1177/0148607187011005465

Cited by 66 publications

(20 citation statements)

References 27 publications

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“…Absolutely nothing is allowed by mouth, not even ice chips. Gastrointestinal tract digestive secretions are inhibited by intravenous histamine receptor antagonists (e.g., famotidine, ranitidine), parenteral anticholinergic agents, and somatostatin and its analogs [8,15]. Occasionally, short-term aspiration of the stomach is initiated with a small nasogastric tube especially if partial or complete mechanical bowel obstruction is present.…”

Section: Alimentary Tract Restmentioning

confidence: 99%

Artificial Nutritional Support in Patients with Gastrointestinal Fistulas

1999

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Gastrointestinal (GI) fistulas allow abnormal diversions of GI contents, digestive juices, water, electrolytes, and nutrients from one hollow viscus to another or to the skin, potentially precipitating a wide variety of pathophysiologic effects. Mortality rates have decreased significantly during the past few decades from as high as 40% to 65% to 5.3% to 21.3% largely as a result of advances in intensive care, nutritional support, antimicrobial therapy, wound care, and operative techniques. The primary causes of death secondary to enterocutaneous fistulas have been, and continue to be, malnutrition, electrolyte imbalances, and sepsis, especially in high-output fistulas, which continue to have a mortality rate of about 35%. Priorities in the management of GI fistulas include restoration of blood volume and correction of fluid, electrolyte, and acid-base imbalances; control of infection and sepsis with appropriate antibiotics and drainage of abscesses; initiation of GI tract rest including secretory inhibition and nasogastric suction; control and collection of fistula drainage with protection of the surrounding skin; and provision of optimal nutrition by total parenteral nutrition (TPN) or enteral nutrition (EN) (or both). The role of nutrition support in the management of enterocutaneous fistulas as either TPN or EN is primarily one of supportive care to prevent malnutrition, thereby obviating further deterioration of an already debilitated patient. It has been shown in several studies that TPN has substantially improved the prognosis of GI fistula patients by increasing the rate of spontaneous closure and improving the nutritional status of patients requiring repeat operations. Moreover, other studies have shown that nutritional support decreases or modifies the composition of the GI tract secretions and is thus considered to have a primary therapeutic role in the management of fistula patients. Finally, if a fistula has not closed within 30 to 40 days, or if it is unlikely to close because of a variety of collateral or compounding pathophysiologic conditions, consideration must be given to operative resection of the fistula while continuing to maintain the previous nutritional and metabolic support. The morbidity and mortality rates in such unfortunate patients remain high despite the many recent advances in surgical and metabolic technology.

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Section: Alimentary Tract Restmentioning

confidence: 99%

Artificial Nutritional Support in Patients with Gastrointestinal Fistulas

1999

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“…There have been reports of fistulas from duodenum, or leakage from biliary-enteric anastomosis, treated with somatostatin or octreotide [18,20,30,31]. However, the only reported primary bile fistu las treated with somatostatin were complica tions of liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of External Biliary, Pancreatic and Intestinal Fistulas with a Somatostatin Analog

Koçak

Bumin²,

Karayalcin³

et al. 1994

Dig Dis

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Somatostatin and its long-acting analog octreotide (SMS 201-995) inhibit several gastrointestinal functions. Their effects have been studied in the treatment of small numbers of external pancreatic, intestinal and biliary fistulas. We treated 8 biliary, 4 pancreatic and 5 intestinal cutaneous fistulas with octreotide. Mean decreases in fistula output before octreotide treatment were not significant (p > 0.01 for each group). On the 1st day of octreotide treatment, mean fistula output decreased from 412 ± 60.4 to 234 ± 57.7 ml in the biliary, from 457.5 ± 57.5 to 217.5 ± 11.8 ml in the pancreatic and from 564 ± 49.2 to 217.5 ± 11.8 ml in the enterocutaneous fistula groups (p < 0.01 for each). No serious side effects were recorded. We conclude that octreotide is an important adjunct in the conservative treatment of external biliary, pancreatic and intestinal fistulas, by decreasing their output.

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“…Still more encour aging was a similar study of TPN and soma tostatin in 37 patients with gastrointestinal fistulae present for at least 21 days before therapy. Spontaneous closure was seen in 27 (73%) of these latter patients, at a mean interval of only 5.4 days after commencing treatment [9]. Such a dramatic response by fistulae previously refractory to spontaneous closure was interpreted as evidence of syner gism between TPN and somatostatin.…”

Section: Octreotide and Gastrointestinal Fistulaementioning

confidence: 97%

Octreotide and Gastrointestinal Fistulae

Scott

Finnegan²,

Irving³

1990

Digestion

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The place of somatostatin and its analogues in the management of gastrointestinal fistulae is reviewed, drawing attention to the difficulty of assessing treatments that influence spontaneous closure. Sixteen patients with gastric, small bowel, and pancreatic fistulae were randomized to receive octreotide injections (100 μg t.i.d.) or placebo for 12 days. Spontaneous fistula closure occurred in 7 at a mean of 37 days after entering the trial. A second study is underway with greater patient numbers recruited from peripheral hospitals and with an increased period of octreotide medication (21 days).

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Treatment of External Gastrointestinal Fistulas by a Combination of Total Parenteral Nutrition and Somatostatin

Cited by 66 publications

References 27 publications

Artificial Nutritional Support in Patients with Gastrointestinal Fistulas

Artificial Nutritional Support in Patients with Gastrointestinal Fistulas

Treatment of External Biliary, Pancreatic and Intestinal Fistulas with a Somatostatin Analog

Octreotide and Gastrointestinal Fistulae

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