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A Meta-analysis of Outcomes Following Use of Somatostatin and Its Analogues for the Management of Enterocutaneous Fistulas

Rahbour, Goher B Med Sci, MBChB, MRCS; Siddiqui, Muhammed R. MBChB, MRCS; Ullah, Mohammad Rehan B Med Sci, MB ChB; Gabe, Simon M. MD, MSc, BSc, MBBS, FRCP; Warusavitarne, Janindra B Med, FRACS, PhD; Vaizey, Carolynne J. MD, FRCS (Gen), FCS (SA)

doi: 10.1097/SLA.0b013e318260aa26
Systematic Reviews and Meta Analyses

Objective: Several randomized control trials (RCTs) have compared somatostatin and its analogues versus a control group in patients with enterocutaneous fistulas (ECF). This study meta-analyzes the literature and establishes whether it shows a beneficial effect on ECF closure.

Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane, and PubMed databases according to PRISMA guidelines. Seventy-nine articles were screened. Nine RCTs met the inclusion criteria. Statistical analyses were performed using Review Manager 5.1.

Results: Somatostatin analogues versus control

Number of fistula closed: A significant number of ECF closed in the somatostatin analogue group compared to control group, P = 0.002.

Time to closure: ECF closed significantly faster with somatostatin analogues compared to controls, P < 0.0001.

Mortality: No significant difference between somatostatin analogues and controls, P = 0.68.

Somatostatin versus control

Number of fistula closed: A significant number of ECF closed with somatostatin as compared to control, P = 0.04.

Time to closure: ECF closed significantly faster with somatostatin than controls, P < 0.00001.

Mortality: No significant difference between somatostatin and controls, P = 0.63

Conclusions: Somatostatin and octreotide increase the likelihood of fistula closure. Both are beneficial in reducing the time to fistula closure. Neither has an effect on mortality. The risk ratio (RR) for somatostatin was higher than the RR for analogues. This may suggest that somatostatin could be better than analogues in relation to the number of fistulas closed and time to closure. Further studies are required to corroborate these apparent findings.

This meta-analysis assesses the efficacy of somatostatin and analogues in the treatment of enterocutaneous fistula. Best results followed the use of somatostatin and lanreotide. The recommendation is for a randomized control trial, as this would benefit an already surgically challenging group of patients associated with a high morbidity and mortality.

St Mark's Hospital and Academic Institute, Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, Watford Road, Harrow, Middlesex, UK.

Reprints: Goher Rahbour, B Med Sci, MBChB, MRCS, St Mark's Hospital and Academic Institute, Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, Watford Road, Harrow, Middlesex HA1 3UJ, UK. E-mail: grahbour@doctors.org.uk.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.