PERIOPERATIVE USE OF OCTREOTIDE IN GASTROINTESTINAL SURGERY

The evolution of gastrointestinal endocrinology has led to the design and application of analogs of gut peptides to treat disease. Octreotid e, a long-acting analog of the inhibitory peptide somatostatin, has pr oven useful in the management of disorders such as carcinoid syndrome and secretory diarrhea due to VIPoma. More recent experience suggests a role for this peptide in the management of certain complications of gastrointestinal surgery. Prophylactic use of octreotide appears warra nted in the prevention of carcinoid crisis in selected patients with c arcinoid syndrome undergoing invasive procedures, and in the preventio n of complications in selected patients undergoing pancreatic surgery. Evidence from placebo-controlled trials supports a role for octreotid e in the management of dumping symptoms in severely affected patients, at least in the short term. Octreotide appears to serve a useful adju nctive role in controlling output from postoperative gastrointestinal fistulae and may hasten closure, particularly in pancreatic fistulae. Selected patients with ileostomy diarrhea and short bowel syndrome ben efit from octreotide treatment, but the long-term value of the peptide in controlling stool output is less clear. Rare patients with other f orms of postoperative secretory diarrhea have been successfully treate d with octreotide. Finally, animal and early human experience suggests that octreotide may have a role as an adjunctive treatment of partial small bowel obstruction. In most of these conditions, the available d ata is sparse and further controlled trials are warranted.