Octreotide plus Total Parenteral Nutrition in Patients with External Digestive Tract Fistulas - An Evaluation of our Experience

Objective: We conducted a retrospective study to evaluate the use of total parenteral nutrition (TPN) and octreotide (OC), in comparison to standard treatment for the management of external digestive tract fistulas (EDTF) at a major tertiary referral University Hospital. Patients: We analyzed the clinical course of 112 patients with EDTF treated from 1978 to 2001. Thirty-nine patients admitted during the period 1978-1990 (group A) and 73 patients admitted during the period 1991-2001 (group B) were studied. Group A received standard supportive treatment while group B received standard supportive treatment in combination with TPN and OC. The main outcome measures were the duration of hospitalization, the fistula spontaneous closure time, the mortality rate and complications of treatment. Results: A dramatic reduction (81 +/- 4.5%) in fistula output was observed within 48 hours after administration of TPN and OC in group B compared to group A (p < 0.05). The incidence of spontaneous fistula closure was increased from 64% in group A to 81% in group B (p < 0.05) and the mean fistula closure time decreased from 38 +/- 2.7 in group A to 17 +/- 1.8 days in group B (p < 0.05). Complications occurred in 61.5% of group A patients and in 45% of patient group B respectively (p< 0.05). The direct fistula related mortality was 7.5% and 2% respectively (p < 0.05). Conclusions: The introduction of TPN and OC in EDTF ameliorated in a statistically significant way all the parameters of EDTF healing that were studied. Although fistula related direct mortality was decreased, further studies with well-designed comparative prospective trials are needed. This abstract was accepted and was be presented as a poster at Digestive Disease Week, Chicago, IL, May 14-19, 2005