Role of octreotide and somatostatin in the treatment of intestinal fistulae

Intestinal fistulae usually arise as a complication of abdominal surgery. I ts treatment is complex and intestinal fistula-related morbidity and mortal ity is high. Fistula closure rates under conservative medical treatment var y between 24 and 72%. Octreotide and somatostatin reduce gastrointestinal, biliary and pancreatic secretion and increase intestinal water and electrol yte absorption. In recent years, octreotide and somatostatin have been asso ciated with conservative medical treatment for patients with intestinal fis tulae. Four placebo-controlled studies have been published within the past 6 years. The interpretation of their results is difficult because patient c ollectives were small and heterogeneous. In one study, somatostatin decreas ed fistula-related complications when compared to placebo, and in another s tudy, octreotide decreased the healing time of intestinal fistulae and the time patients required total parenteral nutrition when compared to placebo. In contrast, the fistula closure rate, hospitalization time and mortality were not influenced by the use of octreotide or somatostatin in conservativ e medical treatment. In conclusion, octreotide and somatostatin actually ca nnot be recommended in the treatment of intestinal fistulae in settings out side of controlled trials.