TREATMENT OF FISTULAS OF THE GASTROINTESTINAL-TRACT WITH TOTAL PARENTERAL-NUTRITION AND OCTREOTIDE IN PATIENTS WITH CARCINOMA

The development of a fistula is a serious postoperative complication. Conservative medical treatment with total parenteral nutrition, skin c are and intensive infection control usually succeeds in closing fistul as (60 to 75 percent), but the treatment is of long duration (two to t hree months), high cost and high morbidity related to prolonged hospit alization. We have used octreotide, a long half-life stomatostatin ana log, in 40 patients from two European university centers with postoper ative enterocutaneous fistulas. Twenty-two patients had low fistula ou tput and 28 patients had high fistula output. Spontaneous closure was achieved in 77.5 percent of the patients after a mean of 13.6 days. On e patient died. Glucose intolerance, which has been reported with stom atostatin treatment of fistulas, was not observed. Previous chemothera py or radiotherapy or low albumin level (23 grams per deciliter) negat ively influenced fistula closure. As an adjunct treatment to primary c are (total parenteral nutrition, skin care and infection control), oct reotide is efficient in reducing fistula output and accelerating spont aneous fistulas closure.