Is octreotide beneficial following pancreatic injury?

Pancreatic injury is often associated with multiple complications related to uncontrolled pancreatic exocrine secretion, including pancreatic fistula, pseudocyst, and intra-abdominal abscesses. Somatostatin analogues such as octreotide have been shown to decrease pancreas-related morbidity following major pancreatic resection in patients with pancreatic neoplasms and acute severe pancreatitis. This study was conducted to determine whether or not the administration of octreotide influences the incidence and severity of abdominal complications following pancreatic injury.

Patients with intraoperative diagnosis of pancreatic injury over a 6-year period were studied retrospectively. Specific complications assessed include abdominal abscesses, pseudocyst, pancreatitis, and pancreatic fistula. Statistical analysis of qualitative variables was by chi-square analysis, and analysis of quantitative variables by Student's t-test (P < 0.05).

Injury to the pancreas was identified in 96 patients. Sixteen early deaths (< 48 hours) and one late death occurred, for a mortality of 18%, leaving 80 patients as the study population; 21 patients received octreotide and 55 patients did not. Pancreatic fistula occurred in 32 patients (40%). When stratified by pancreatic injury severity, there was no significant difference in complication rates, although patients treated with octreotide had a higher rate of fistula formation (48% versus 40%), longer duration of fistula drainage, and longer hospital stay compared with untreated patients.

Although adverse patient selection may be a factor in this retrospective survey, the magnitude of observed differences raises concerns regarding the empiric administration of octreotide to such patients pending prospective study.