Octreotide plus Total Parenteral Nutrition in Patients with External Digestive Tract Fistulas – An Evaluation of our Experience

Abstract

Objective: We conducted a retrospective study to evaluate
the use of total parenteral nutrition (TPN) and octreotide
(OC), in comparison to standard treatment for the management
of external digestive tract fistulas (EDTF) at a
major tertiary referral University Hospital.
Patients: We analyzed the clinical course of 112 patients
with EDTF treated from 1978 to 2001. Thirty-nine patients
admitted during the period 1978-1990 (group A) and 73
patients admitted during the period 1991-2001 (group B)
were studied. Group A received standard supportive treatment
while group B received standard supportive treatment
in combination with TPN and OC. The main outcome measures
were the duration of hospitalization, the fistula spontaneous
closure time, the mortality rate and complications
of treatment.
Results: A dramatic reduction (81±4.5%) in fistula output
was observed within 48 hours after administration of TPN
and OC in group B compared to group A (p<0.05). The
incidence of spontaneous fistula closure was increased from
64% in group A to 81% in group B (p<0.05) and the mean
fistula closure time decreased from 38±2.7 in group A to
17±1.8 days in group B (p<0.05). Complications occurred
in 61.5% of group A patients and in 45% of patient group B
respectively (p<0.05). The direct fistula related mortality
was 7.5% and 2% respectively (p<0.05).
Conclusions: The introduction of TPN and OC in EDTF
ameliorated in a statistically significant way all the parameters
of EDTF healing that were studied. Although fistula
related direct mortality was decreased, further studies with
well-designed comparative prospective trials are needed.
This abstract was accepted and was be presented as a poster
at Digestive Disease Week, Chicago, IL, May 14-19, 2005
Keywords: digestive tract fistulas, octreotide, total parenteral
nutrition