OCTREOTIDE FOR TREATMENT OF POSTOPERATIVE ALIMENTARY-TRACT FISTULAS

Eighteen patients with postoperative fistulas of the gastrointestinal tract were treated with the somatostatin analog octreotide between Nov ember 1989 and November 1992, Fourteen patients had enterocutaneous fi stulas: seven from the duodenum and seven from the ileum, Another thre e patients had pancreatic fistulas, and one patient had a biliary fist ula, Within 24 hours of octreotide treatment, a mean reduction of 52% in the intestinal fistulas' output, 40% in the pancreatic fistulas, an d 30% in the biliary fistula was noted, In the intestinal fistulas gro up the closure rate was 72% after a mean of 11 days, Early closure (me an 6 days) was achieved in all three pancreatic fistulas. In the patie nt with the biliary fistula a 30% reduction was observed twice followi ng the administration of octreotide, and an increase occurred when it was withheld, The reduction rate of the secretions in high-output inte stinal fistulas (>500 ml/day) was higher than in the low-output fistul as (63 +/- 8% versus 39 +/- 4%, p < 0.05). Fistula output and the init ial response to octreotide treatment had no value in predicting sponta neous healing, In conclusion, octreotide is a valuable tool for the co nservative treatment of fistulas of the digestive tract, It is especia lly valuable for management of high-output enteric fistulas and pancre atic fistulas.