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High dose octreotide in the management of acute pancreatitis
O Karakoyunlar1, E Sivrel, N Tanir
1SSK Izmir Training Hospital, Department of 1st General Surgery, Turkey. okarakoyunlar@superonline.com
Background/Aims:
Controversial results are present in clinical studies on the effect of octreotide in the treatment of patients with acute pancreatitis. The aim of this study was to analyze the effect of octreotide in biochemical, physiological and radiological prognostic criteria of acute pancreatitis at the end of 48 hours.
Methodology:
Between January 1995 and August 1997, we conducted a prospective controlled clinical study. Forty-three patients with a diagnosis of acute pancreatitis (acute abdominal pain and a serum amylase >1000 IU/liter) were sequentially allocated to treatment with high dose octreotide (N=22), 0.5 microg/kg/hr by continued i.v. infusion, or designated as controls (N=21). The other aspects of the treatment protocol were similar in both groups.
Results:
There was no significant difference between the two groups on admission with regard to Ranson criteria (P=0.13). A significant difference was not observed in fasting blood glucose, albumin, calcium, hemoglobin, hematocrit, white blood cell count, LDH, AST, urea, systolic and diastolic pressure, heart rate and pyrexial changes between the two groups at admission and at the end of 48 hours (p>0.05), but serum amylase changes were significantly different (p=0.000). Pleural effusion at the end of 48 hours was more frequent in the octreotide treated group (22.7% vs. 9.5%, p>0.05), but pancreatic edema (52.4% vs. 13.6%, p=0.022), ascites (19.5% vs. 4.5%, p>0.05) and retroperitoneal edema (4.76% vs. 4.5%, p>0.05) were observed more frequently in the control group. One death occurred in each group. Patients treated with octreotide tolerated oral intake sooner than the control group (3.76 vs. 4.9 days, p=0.041).
Conclusions:
Although biochemical and physiologic changes between the two groups were not significantly different, a more pronounced decrease in serum amylase levels, improvements in pancreatic edema and earlier return to oral intake in the high dose-octreotide group suggest that octreotide may have a beneficial role in the management of acute pancreatitis.