The effects of somatostatin and octreotide on the human sphincter of Oddi

Objective Somatostatin acts at different sites in the human gastrointestina l tract and generally inhibits the release and effects of many gastrointest inal hormones and neuropeptides. Together with its long-acting analogue oct reotide, somatostatin is widely used in the treatment of hormone-producing tumours, variceal bleeding, etc., but multi-centre trials have failed to pr ove a beneficial effect in the treatment of acute pancreatitis or in the pr evention of post-ERCP pancreatitis (pancreatitis following endoscopic retro grade cholangiopancreatography). The aim of the present work was to study t he effects of somatostatin and octreotide on the human sphincter of Oddi by means of quantitative hepatobiliary scintigraphy (QHBS), Method Fifteen cholecystectomized patients were enrolled in the study, six in the somatostatin group and nine in the octreotide group, QHBS was perfor med initially with a standard protocol (baseline data), then repeated after 0.1 mg octreotide or a 250 mu g bolus + 250 mu g/h somatostatin administra tion, In the 60th min of QHBS, 0.5 mg glyceryl trinitrate (GTN) was adminis tered sublingually. Results QHBS demonstrated that both somatostatin and octreotide caused a ma rked impairment in the bile flow: the half-time of excretion (T-1/2) over t he common bile duct was significantly prolonged compared with baseline data (somatostatin group: common bile duct T-1/2 180 min versus 59.7 +/- 31 min ; octreotide group: common bile duct T-1/2 140.9 +/- 60.5 min versus 30.7 /- 11.7 min). Glyceryl trinitrate administration accelerated the transpapil lary bile flow, with significant decreases in the elevated T-1/2 in both gr oups, Conclusion Increased transpapillary flow induced by glyceryl trinitrate may be beneficial in the treatment of acute or post-ERCP pancreatitis. fur J G astroenterol Hepatol 11:897-901 (C) 1999 Lippincott Williams & Wilkins.