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Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review
Charles C Roehr1, Andreas Jung, Hans Proquitté
1Department of Neonatology, Charité Campus Mitte, Universitätsmedizin Berlin, Schumannstrasse 20-21, 10098, Berlin, Germany, and John Radcliffe Hospital, Department of Paediatric Surgery, Oxford, UK. christoph.roehr@charite.de
Insights
Somatostatin and octreotide show positive treatment effects for pediatric chylothorax, a rare condition. While generally safe, careful use is advised in high-risk patients, and further research is needed for standardized protocols.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Pharmacology
Background:
- Chylothorax is a rare, life-threatening condition in children with no established treatment protocol.
- Somatostatin and octreotide are emerging treatments for pediatric chylothorax.
Purpose of the Study:
- To summarize evidence on the efficacy and safety of somatostatin and octreotide in treating pediatric chylothorax.
Main Methods:
- Systematic review of peer-reviewed articles from Cochrane Library, EMBASE, and PubMed.
- Included 35 children with chylothorax treated with either somatostatin (10) or octreotide (25).
Main Results:
- Both somatostatin and octreotide demonstrated positive treatment effects in most cases.
- Reported side effects included gastrointestinal issues, transient hypothyroidism, and elevated liver function tests.
- Serious adverse events like strangulation-ileus and necrotizing enterocolitis were noted in specific high-risk cases.
Conclusions:
- Somatostatin and octreotide appear effective for pediatric chylothorax but require cautious use in at-risk populations.
- Systematic clinical research is essential to establish definitive efficacy and develop safe, standardized treatment protocols.
Objective:
Chylothorax is a rare but life-threatening condition in children. To date, there is no commonly accepted treatment protocol. Somatostatin and octreotide have recently been used for treating chylothorax in children. We set out to summarise the evidence on the efficacy and safety of somatostatin and octreotide in treating young children with chylothorax.
Design:
Systematic review: literature search (Cochrane Library, EMBASE and PubMed databases) and literature hand search of peer reviewed articles on the use of somatostatin and octreotide in childhood chylothorax.
Patients:
Thirty-five children treated for primary or secondary chylothorax (10/somatostatin, 25/octreotide) were found.
Results:
Ten of the 35 children had been given somatostatin, as i.v. infusion at a median dose of 204 microg/kg/day, for a median duration of 9.5 days. The remaining 25 children had received octreotide, either as an i.v. infusion at a median dose of 68 microg/kg/day over a median 7 days, or s.c. at a median dose of 40 microg/kg/day and a median duration of 17 days. Side effects such as cutaneous flush, nausea, loose stools, transient hypothyroidism, elevated liver function tests and strangulation-ileus (in a child with asplenia syndrome) were reported for somatostatin; transient abdominal distension, temporary hyperglycaemia and necrotising enterocolitis (in a child with aortic coarctation) for octreotide.
Conclusions:
A positive treatment effect was evident for both somatostatin and octreotide in the majority of reports. Minor side effects have been reported, however caution should be exercised in patients with an increased risk of vascular compromise as to avoid serious side effects. Systematic clinical research is needed to establish treatment efficacy and to develop a safe treatment protocol.
