OCTREOTIDE AS AN ADJUNCT TO HOME PARENTERAL-NUTRITION IN THE MANAGEMENT OF PERMANENT END-JEJUNOSTOMY SYNDROME

Intravenous fluid requirements for patients with permanent end-jejunos tomy syndrome often exceeds 3 L/d, making rehabilitation difficult. Th e effect of the somatostatin analogue, octreotide (100 mug TID, subcut aneously) in reducing requirements was measured in 10 patients establi shed on home parenteral nutrition. After 10 days of treatment, 72-hour balance measurements demonstrated significant reductions in stomal fl uid and electrolyte losses from (mean +/- SE) 8.1 4 +/- 1.8 to 4.8 +/- 0.7 Ud (P < .03), sodium from 510 +/- 71 to 340 +/- 41 mEq/d (p < .03 ), chloride from 533 +/- 70 to 315 +/- 32 mEq/d (p < .002), and potass ium from 101 +/- 41 to 79 +/- 34 mEq/d (p < .02), permitting an averag e reduction in intravenous fluid requirements of 1.3 Ud (p < .0003), 1 18 mEq Na/d (p < .03), 41 mEq K+/d (p < .02), and 178 mEq Cl-/d (p < . 01). This meant that daytime intravenous infusions could be stopped in all patients. Fecal nitrogen losses were decreased (p < .05), but ove rall there was no significant change in fat and caloric absorption. In addition, hormonal stimulated gastric acid and pancreatic lipase secr etions were significantly reduced (p < .05). The effect was most marke d in those patients with massive stomal losses and uncontrollable thir st. Continuation of treatment for more than 1 year in 8 of the patient s suggested preservation of potency and good tolerance, with the possi ble exception of accelerated gallstone formation and subacute intestin al obstruction. In conclusion, octreotide has the potential to improve the quality of life of those end-jejunostomy syndrome patients with m assive stomal losses, resistant to conventional medical treatment.