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Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula

Stevens, Philip; Foulkes, Rhiannon E.; Hartford-Beynon, Jake S.; Delicata, Raymond J.

European Journal of Gastroenterology & Hepatology: October 2011 - Volume 23 - Issue 10 - p 912–922
doi: 10.1097/MEG.0b013e32834a345d
Original Articles: Colorectal Disorders

Objective Somatostatin analogues may help pancreatic fistula although it remains unclear whether they help nonpancreatic fistula. This study involved meta-analysis of somatostatin analogues for treatment of enterocutaneous fistula.

Methods Meta-analysis of studies was undertaken, to estimate the effect of somatostatin analogues on spontaneous closure, time to closure and mortality.

Results Results showed significant associations between somatostatin and both spontaneous closure rate [odds ratio (OR) 6.61, 95% (CI) confidence interval 1.35–32.43] and time to closure (standardized mean difference −0.80, 95% CI: −1.34 to −0.26). Octreotide reduced closure time (standardized mean difference −0.57, 95% CI: −0.95 to −0.20) but not spontaneous closure (OR: 1.74, 95% CI: 0.64–4.76). Lanreotide also improved time to closure (mean of 17 days vs. 26 days, standard deviation not stated) but not spontaneous closure (OR: 0.94, 95% CI: 0.42–2.12). Somatostatin, octreotide and lanreotide did not significantly affect mortality (OR: 0.30, 0.82, and 0.48; 95% CI: 0.03–3.47, 0.38–1.78, and 0.04–5.07 respectively).

Conclusion Somatostatin and octreotide improved fistula closure time but only somatostatin improved spontaneous closure rate.

Department of General Surgery, Nevill Hall Hospital, Abergavenny, Wales, UK

Correspondence to Philip Stevens, MBBCh (Hons), FRCS (Gen Surg), MSc, Department of General Surgery, Nevill Hall Hospital, Brecon Road, Abergavenny, NP7 7EG, Wales, UK Tel: +33 44 1873 732 732; fax: +33 44 1873 732 752; e-mail: Stevens_P1@hotmail.com

Received May 25, 2011

Accepted June 22, 2011

© 2011 Lippincott Williams & Wilkins, Inc.