Role of somatostatin analogues in the management of enterocutaneous fistulae.

OBJECTIVE To observe beneficial effects of somatostatin analogues in terms of time taken by the enterocutaneous fistula to close, total hospital stay, cost of treatment and mortality. DESIGN A comparative study. PLACE AND DURATION OF STUDY The study was carried out from 01-10-1999 to 30-09-2002 in Surgical Units of Bahawal Victoria Hospital, Bahawalpur. PATIENTS AND METHODS In this study 33 patients were distributed randomly in two groups. Both groups were almost similar in terms of age, sex, anatomical location and cause of enterocutaneous fistulae. In group-A, 17 patients were treated by conventional methods (nil per orum, total parenteral nutrition, antibiotics, skin and wound care and control of sepsis). While in group-B, 16 patients were treated by long acting somatostatin analogue (Sandostatin 300 microgram subcutaneously /day in three divided doses) in addition to the conventional treatment. RESULTS Of the 33 patients studied, 52% enterocutaneous fistulae were arising from ileum, 18% from jejunum, 12% from colon, 9% from biliary tree/pancreas, 6% from duodenum, and 3% from appendix. Low output fistulae (less than 200 ml/24 hour) were 24.24% in group A and 18.18% in group-B. Moderate output fistulae were 15.15% and 21.21% respectively. High output fistulae (>500 ml/ 24 hours) were 12.12% and 9.10% respectively. Etiologically, 85% were post-operative, 9% traumatic, 3% tuberculous and 3% due to inflammatory bowel disease. Fifty-two percent patients having fistula were malnourished, and 60% were anemic. In group-B with somatostatin the fistula closure time and hospital stay were marginally decreased, which was statistically insignificant. The cost of treatment was statistically significant in same group. In all the 33 patients studied, fistula closed except in 5 who expired. Mortality was not affected by the use of somatostatin. CONCLUSION Somatostatin and its analogues can be used to decrease fistula output, thus making enterocutaneous fistulae easy to manage in terms of fluid and electrolytes and protein imbalances. Somatostatin and its analogues have shown some beneficial effects with regard to fistula closure rate and hospital stay, but the effects are statistically insignificant. There was significant increase in the cost of treatment. Thus the role of somatostatin is not established in the closure of enterocutaneous fistula.