Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula

Nutrition and management of enterocutaneous fistula

BACKGROUND

The management of enterocutaneous fistula is challenging, with significant associated morbidity and mortality. This article reviews treatment, with emphasis on the provision and optimal route of nutritional support.

METHODS

Relevant articles were identified using Medline searches. Secondary articles were identified from the reference lists of key papers.

RESULTS AND CONCLUSION

Management of enterocutaneous fistula should initially concentrate on correction of fluid and electrolyte imbalances, drainage of collections, treatment of sepsis and control of fistula output. The routine use of somatostatin infusion and somatostatin analogues remains controversial; although there are data suggesting reduced time to fistula closure, there is little evidence of increased probability of spontaneous closure. Malnutrition is common and adequate nutritional provision is essential, enteral where possible, although supplemental parenteral nutrition is often required for high-output small bowel fistulas. The role of immunonutrition is unknown. Surgical repair should be attempted when spontaneous fistula closure does not occur, but it should be delayed for at least 3 months.

Abnormal liver function tests in a patient fed with total parenteral nutrition and treated with octreotide

Octreotide is a long-acting analog of somatostatin, a hypothalamic release-inhibiting hormone. It is sometimes used therapeutically to relieve symptoms associated with acromegaly and gastroenteropancreatic endocrine tumors. It has also been used in the treatment of short-bowel syndrome and gastrointestinal and biliary fistulae. We report a patient with biliary leakage due to Marizzi's syndrome treated with total parenteral nutrition and octreotide who developed abnormal liver function tests that improved when the two treatments were stopped. We also review the literature regarding abnormal liver function tests in patients on total parenteral nutrition.