Dataset Information

IS PROPHYLACTIC USE OF OCTREOTIDE BENEFICIAL IN PREVENTING COMPLICATIONS AFTER PANCREATIC SURGERY?

ABSTRACT: Major complications following pancreatic surgery are related to the digestive exocrine secretions of the gland. Octreotide, a potent inhibitor of the pancreatic secretions may be of value in reducing the complication rate, particularly fistula formation and possibly the mortality after pancreatic surgery. Between Jan 97 and Jun 99, 19 patients who underwent pancreatic surgery were given perioperative Octreotide in a dose of 100 micrograms eight hourly for 7 days starting from the morning of the surgery. The post operative complications were compared with the results of 17 patients who underwent similar pancreatic surgery between Jan 94 to Dec 96 and who were not given perioperative Octreotide. The surgeries conducted in the Octreotide group were pancreatico-duodenectomy 6, lateral pancraetico-jejunostomy 7, pancreatic biopsy 4 and surgery for pancreatic trauma 2. In the non Octreotide group the surgeries done were pancreatico-duodenectomy 7, lateral pancreatico-jejunostomy 6, pancreatic biopsy 3 and surgery for pancreatic trauma 2. Only 1 out of 19 patients in the Octreotide group developed pancreatic fistula. This was after a pancreaticoduodenectomy and closed spontaneously after 7 days. In the non Octreotide group 5 out of 17 patients developed pancreatic fistula. Of these 5, 1 patient died while in remaining 4 the mean fistula closure time was 23 days. Octreotide reduces the incidence of pancreatic fistula after pancreatic surgeries. However, a larger prospective study is required to convincingly prove the efficacy of Octreotide in prevention of pancreatic fistula after pancreatic surgery.

SUBMITTER: Chaudhry R

PROVIDER: S-EPMC5532127 | biostudies-other | 2000 Oct

REPOSITORIES: biostudies-other

ACCESS DATA

Similar Datasets

Project description:The use of octreotide prophylaxis in the prevention of complications after pancreatic resection remains controversial. The aim of this systematic review and meta-analysis was to evaluate the efficacy of octreotide prophylactic treatment to prevent complications after pancreatic resection.Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched for eligible studies from 1980 to November 2016 with the limitation of human subjects and randomized controlled trials (RCTs). Data were extracted independently and were analyzed using RevMan statistical software version 5.3 (Cochrane Collaboration, http://tech.cochrane.org/revman/download). Weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration risk of bias tool was used to assess the risk of bias.Twelve RCTs comprising 1902 patients were identified as eligible. The methodological quality of the trials ranged from low to moderate. A pooled analysis of effectiveness based on the data from each study revealed that octreotide could significantly reduce the rate of pancreatic fistula (PF) after pancreatic resection (RR?=?0.75, 95% CI?=?0.57-0.98, P?=?.04). The same findings were discovered in multicenter and European subgroups with a subgroup analysis; no obvious differences were noted in American, Asian, and single-center subgroup analyses. An equal effect was observed between the use or non-use of octreotide groups regarding mortality (RR?=?1.24, 95% CI?=?0.77-2.02, P?=?.38). Octreotide had no advantages in regards to mortality improvement. The total numbers of complications associated with the use or non-use of octreotide were similar (RR?=?0.77, 95% CI?=?0.58-1.03, P?=?.08). Among the high-risk group, octreotide was more effective in reducing complications (RR?=?0.61, 95% CI?=?0.46-0.82, P?=?.0009). Compared with the patients who did not receive prophylactic treatment, the patients who underwent pancreatic resection benefited from octreotide because it had better efficacy in preventing fluid collection and postoperative pancreatitis.The prophylactic use of octreotide is suitable for preventing postoperative complications, especially PF and fluid collection as well as postoperative pancreatitis. However, no obvious differences were noted regarding mortality. In view of the clinical heterogeneity and varying definitions of PF, whether these conclusions are broadly applicable should be further determined in future studies.

Project description:BACKGROUND: Octreotide is used in many centres to prevent complications after pancreatic surgery. Delayed gastric emptying is a another complication occurring in around 30% of patients after pancreatoduodenectomy (PD) and causes prolonged hospital stay. The influence of octreotide on this complication is doubtful. AIMS: To assess the effect of octreotide, at the clinical dosage used after pancreatic surgery, on gastric emptying in healthy volunteers. SUBJECTS AND METHODS: Eight healthy male volunteers (mean age 22.5 years) participated in this double blind, placebo controlled study. On day 1 subjects received 100 micrograms of octreotide or placebo subcutaneously, three times daily and on day 2, one hour after the fourth injection, gastric emptying, postprandial cholecystokinin (CCK) release, and mouth to caecum transit time (MCTT) were measured. This protocol was repeated after one week, in a crossover design. On the test day subjects received a liquid test meal (1.57 MJ/300 ml) and gastric emptying measurements were performed with applied potential tomography, an non-invasive, validated technique which measures gastric emptying through impedance differences. From the gastric emptying curves, lag time, t50, and postlag emptying rate were measured. MCTT was measured using the hydrogen breath test. RESULTS: Lag time decreased from 29.6 (6.3) (mean (SEM)) to 12.2 (4.6) minutes (p < 0.05) during octretide treatment; t50 decreased from 87.8 (12.0) to 47.5 (8.2) minutes (p < 0.02) and there was a trend towards an increased postlag emptying rate (0.8 to 1.6% per minute; p = 0.07). MCTT increased from 150 (12.7) to 229 (17.9) minutes during octreotide treatment (p < 0.01). Octreotide suppressed postprandial CCK release (p < 0.05). CONCLUSIONS: MCTT was delayed by octreotide, suggesting impairment of small bowl treatment. Octreotide administered at the clinical dosage for pancreatic surgery accelerates gastric emptying, mainly by shortening the lag time. Suppression of postprandial CCK release may be involved in this process. Octreotide administration is therefore not a contributing factor in the pathogenesis of delayed postoperative gastric emptying after PD and might even play a role in preventing this complication.

Dataset Information

IS PROPHYLACTIC USE OF OCTREOTIDE BENEFICIAL IN PREVENTING COMPLICATIONS AFTER PANCREATIC SURGERY?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets