PRELIMINARY-REPORT OF A PROSPECTIVE RANDOMIZED STUDY OF OCTREOTIDE INTHE TREATMENT OF SEVERE ACUTE-PANCREATITIS

BACKGROUND: Experimental and clinical studies on the effect of octreot ide in the treatment of patients with acute pancreatitis have presente d controversial results. Since January 1992, we have been conducting a prospective randomized study on the clinical effect of octreotide in severe acute pancreatitis, at three hospitals in Israel. STUDY DESIGN: The entering criteria included three or more of the Ranson's prognost ic signs and computed tomographic findings of severe pancreatitis. Pat ients were randomly assigned to conservative treatment either with or without octreotide (0.1 mg injected subcutaneously three times a day). The end points of the study included: complication rate (adult respir atory distress syndrome [ARDS], sepsis, renal failure, pseudocyst, fis tula, and abscess), length of hospital stay, and mortality. RESULTS: D uring the first two years (from January 1992 to December 1993), 51 pat ients entered the study. After evaluation, 13 patients were excluded d ue to failure to meet the entering criteria, incomplete data, or incor rect diagnosis. Of the remaining 38 patients, 19 were assigned to octr eotide (treatment group) and 19 to conservative treatment alone (contr ol group). The two groups were matched with regard to age, sex, etiolo gy, and severity of disease. The complication rate was lower in the tr eatment group compared with the control group with regard to sepsis (2 6 compared with 74 percent, p=0.004) and ARDS (37 compared with 63 per cent, p=0.1). The hospital stay was shorter in the treatment group com pared with the control group (17.9 compared with 34.1 days, p=0.02). D eath occurred in two patients in the treatment group and six patients in the control group. CONCLUSIONS: Although some of the parameters did not reach statistical significance, these preliminary results suggest that octreotide may have a beneficial effect in the treatment of pati ents with severe acute pancreatitis. This study is scheduled to contin ue for two more years.