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Somatostatin-based therapies for external gastrointestinal fistulas: Updated meta-analysis of randomized clinical
Marcelo Augusto Fontenelle Ribeiro Junior1,2, Lucas Fontenelle Vieira3, Husna Irfan Thalib4
1Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, United States.
Background:
External gastrointestinal fistulas (EGIFs) are serious postoperative complications associated with prolonged hospital stays, sepsis, malnutrition, and high mortality rates. Reducing gastrointestinal secretions with somatostatin or its analogues may facilitate fistula closure. The clinical effectiveness of these therapies, however, remains uncertain.
Aim:
To investigate the effectiveness of somatostatin-based therapy for EGIFs.
Methods:
A systematic review and meta-analysis (Prospero CRD420251054344) of nine randomized controlled trials (442 patients) compared somatostatin-based therapies with standard care in tertiary care settings. Protocols included somatostatin, octreotide, or lanreotide, administered at various dosages (250 micrograms/hour intravenous infusion or 100 micrograms subcutaneous injection three times daily) for 7 to 56 days. Primary outcomes were fistula closure rates and time to closure. Secondary outcomes were hospital length of stay, complications, need for surgical intervention, and mortality. Mean differences and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Risk of bias was assessed with the Cochrane RoB 2 tool.
Results:
There was no statistically significant difference in closure rate (RR: 1.11, 95%CI: 0.95-1.28, P = 0.19, I² = 0%) between 134/193 patients receiving somatostatin-based therapy and 99/170 control patients. Time to closure was reduced by 6.16 days (mean difference -6.16, 95%CI: -7.44 to -4.88, P < 0.001, I² = 0%) in 126 patients in intervention group vs 114 in control group. Hospital stay was shortened by 4.00 days (mean difference -4.00, 95%CI: -7.99 to -0.01, P = 0.05, I² = 0%) in 56 vs 62 patients. There were no differences in complications (RRs: 0.76, 95%CI: 0.55-1.05), need for surgical intervention (RRs: 0.67, 95%CI: 0.38-1.19), or mortality (RRs: 0.77, 95%CI: 0.44-1.35). Limitations include small sample sizes, heterogeneity in treatment regimens, and inconsistent outcome definitions, which may affect generalizability. Limited data for some outcomes, such as hospital stay, and exclusion of some datasets for methodological reasons reduced statistical power.
Conclusion:
Somatostatin-based therapies did not significantly improve fistula closure rates but were associated with shorter time to closure and hospital stay. Mortality, complications, and surgical intervention requirements remained unchanged, suggesting that these therapies may serve only as an adjunctive option in selected patients.
