THE RELATIVE EFFECTIVENESS OF SOMATOSTATIN AND OCTREOTIDE THERAPY IN PANCREATIC DISEASE

Somatostatin and octreotide inhibit basal and stimulated pancreatic se cretion, stimulate reticuloendothelial system activity, modulate the c ytokine cascade and are cytoprotective with respect to the pancreas, T hese effects of somatostatin and octreotide suggest that both drugs ma y be useful either in the treatment of pancreatic disorders, or in pre venting acute pancreatitis following procedures on the pancreas, In re cent years it has become clear that somatostatin is a useful and effec tive therapy for severe acute pancreatitis and in preventing complicat ions following endoscopic retrograde cholangiopancreatography (ERCP), whereas octreotide has no beneficial effect and may be deleterious in both these indications, The differences in the therapeutic efficacy of somatostatin and octreotide in acute pancreatitis and ERCP appears to be related to their differential effects on sphincter of Oddi motilit y - the native hormone relaxing, and the analogue increasing, its cont ractility, Consequently, any beneficial effects of octreotide in both acute pancreatitis and ERCP are offset by the increased contractility of the sphincter of Oddi, which results in retention of activated enzy mes within the pancreas and further autodigestion of the gland, Somato statin and octreotide are equally effective in promoting the closure o f pancreatic fistulae, However, the time to closure after commencement of therapy is much more variable and longer in patients treated with subcutaneous octreotide than those receiving intravenous somatostatin, possibly as a result of fluctuations in pancreatic enzyme secretion b etween consecutive administrations of the hormone, Furthermore, the in itial potent inhibitory effect of octreotide on pancreatic secretion i s lost after 7 days of continuous subcutaneous administration, Therefo re, in terms of cost-effectiveness, somatostatin would appear to be th e treatment of choice for pancreatic fistulae. Octreotide markedly red uces the complication rates after elective pancreatic surgery, It rema ins to be established whether somatostatin is as effective as octreoti de in this indication.