The benefit of octreotide (somatostatin
analogue) in pancreatic trauma is not clear. Its mechanism is two-fold: 1) it
suppresses the secretion of gastrointestinal hormones that stimulate the
pancreas and 2) it is a direct inhibitor of somatostatin receptors on the
pancreatic acinar cells. Amirata et al [1] had the first and most complete
nonrandomized study of use of octreotide after pancreatic trauma between 1988 and
1992, looking at 28 patients from Newark, New Jersey. 7 of the patients sustained blunt injury and
21 patients sustained penetrating injury.
The majority of injuries were grade II (included parenchymal
injury). 7 of the patients were treated
prophylactically with octreotide (150 – 300 mcg per day) beginning on day
1. None of these patients had any
pancreatic complications compared to the injury severity and grade matched
no-octreotide cohort that had a 21% pancreatic complication rate. The study concluded that prophylactic
octreotide is safe and has no negative sequelae.
On the other hand, Nwariaku et al [2] studied
76 patients with pancreatic injury (85% penetrating injury) to see if empiric
octreotide decreased the incidence of pancreatic complications. 21 patients
received octreotide and the remainder did not.
When matched by injury scale, there was no difference in pancreatic
complications between the octreotide and no-octreotide groups. The group concluded that empiric octreotide
does not benefit patients who sustain pancreatic trauma.
Although there may be a minor role for
octreotide in major pancreatic disruption and treatment of fistula [3,4], that
role is not evidence based and octreotide is therefore not
recommended. Further prospective randomized control trials are needed.
1) Amirata E,
Livingston DH, Elcavage J. Octreotide acetate decreases pancreatic
complications after pancreatic trauma. American Journal of Surger Vol 168 (4)
1994, 345-347
2) Mwariaku FE,
Terracina A, Mileski WJ et al. Is octreotide beneficial following pancreatic
injury? Am J Surg. 1995 Dec; 170(6):582-5.
3) Lochan R, Sen G,
Barrett AM et al. Management strategies in isolated pancreatic trauma. J
Hepatobiliary Pancreat Surg (2009) 16: 189 – 196.
4) Degianis E, Glapa
M, Loukogeorgakis SP. Management of pancreatic trauma. Injury, Int. J. Care
Injured (2008) 39, 21-29.
from David D Shersher, MD
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