Use of Octreotide for healing of pancreaticoenteric anastomosis

RATIONALE:

• by decreasing the volume of pancreatic secretion, the pancreatic fistula rate would be decreased because of which the pancreaticoenteric anastomosis would heal better.
• Treatment with octreotide is proposed to decrease nutrient and electrolyte losses and promote fistula closure. Benefits of these actions would include decreased hospital stays, complication rates, and decreased overall cost of treatment

EVIDENCES

• Five RCTs from Europe and 1 RCT from Asia showed the benefit of perioperative use of somatostatin analogues to decrease the postoperative complication rate.
• On the other hand, 2 recent RCTs from Europe and 3 RCTs from USA tates failed to show benefit
• 10 studies and showed that somatostatin and its analogues reduced rate of biochemical fistula but not the incidence of clinical anastomotic disruption
• In another report involving seven studies, the perioperative octreotide administration was associated with significant reduction of pancreatic fistula rate after pancreatic surgery
• However the risk reduction was not associated with a significant difference in postoperative mortality.

RECOMMENDATION

• prophylactic use of perioperative somatostatin and its analogues to prevent pancreas-related complications after pancreatic surgery remains controversial.
• It does not result in a reduction of mortality.
• However the efficacy of prophylactic octreotide is reported to be improved, by selective administration in the setting of high risk glands, including patients with either soft glands or small pancreatic duct, in those harbouring ampullary, duodenal cystic or islet lesions, or in case where intraoperative blood loss is excessive
• Prophylactic octreotide did not influence clinically relevant fistula rates among low-risk glands. Thus the usage may incur high treatment cost without any significant additional benefit
• In addition, surgeons experience has been shown to correlate with pancreatic anastomotic leakage rate and in some reported cases the prophylactic use of somatostatin

DOSING:

• SC 0.1mg (up to 0.25mg in some references) TDS for 7 days (5-8 days)
• If clinical significant reduction in fistula output is  not evident within 5-8 days, octreotide therapy should be discontinued

REFERENCES:

1. Pancreatic Fistula after Pancreatectomy: Definitions, Risk Factors, Preventive Measures, and Management Review http://www.hindawi.com/journals/ijso/2012/602478/

2. Use of Octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systemic review and meta analysis

3. OCTREOTIDE IN THE PREVENTION AND TREATMENT OF GASTROINTESTINAL AND PANCREATIC FISTULAS. Department of Surgical Education, Orlando Regional Medical Center (2005)

4. Therapeutic applications of octreotide in pediatric patients http://www.saudijgastro.com/text.asp?2012/18/2/87/93807

5. Does Prophylactic Octreotide Decrease the Rates of Pancreatic Fistula and Other Complications After Pancreaticoduodenectomy?http://www.cinj.org/sites/cinj/files/documents/ProphylacticOctreotide.pdf