BACKGROUND: Enterocutaneous fistulas are abnormal connections between the skin and gastrointestinal tract that most commonly occur after surgery. Somatostatin analogues have been used in their treatment. The objective of the present study was to determine if somatostatin analogues shorten the time to closure of postoperative enterocutaneous fistulas compared to placebo. METHODS: We searched Medline, EMBase, the Cochrane Central Register of Controlled Trials, as well as reference lists of textbooks and relevant articles for randomized controlled trials (RCT) comparing somatostatin analogues to control in the treatment of postoperative enterocutaneous fistulas. We systematically assessed trials for eligibility and validity, and extracted data in duplicate. We pooled data across studies using a random effects model. RESULTS: Our initial search yielded 720 studies, of which eight RCT ultimately met eligibility criteria and were included in this review. Somatostatin analogues significantly decreased the time to closure of fistulas compared to placebo {weighted mean difference (WMD)--6.37 days [95% confidence interval (CI) -8.33, -4.42]}. The duration of hospital stay was also significantly decreased with somatostatin analogue treatment [WMD--4.53 days (95% CI -8.29, -0.77)]. No difference in mortality was identified with somatostatin treatment [RR 0.87 (95% CI 0.49-1.55)]. CONCLUSIONS: Somatostatin analogues appear to decrease the duration of enterocutaneous fistulas and duration of hospital stay, but no mortality benefit was identified. The quality of evidence for outcomes in this review ranged from low to moderate. Future large, blinded, RCT would be useful in improving the confidence in the treatment effects identified in this systematic review and meta-analysis.
BACKGROUND:Enterocutaneous fistulas are abnormal connections between the skin and gastrointestinal tract that most commonly occur after surgery. Somatostatin analogues have been used in their treatment. The objective of the present study was to determine if somatostatin analogues shorten the time to closure of postoperative enterocutaneous fistulas compared to placebo. METHODS: We searched Medline, EMBase, the Cochrane Central Register of Controlled Trials, as well as reference lists of textbooks and relevant articles for randomized controlled trials (RCT) comparing somatostatin analogues to control in the treatment of postoperative enterocutaneous fistulas. We systematically assessed trials for eligibility and validity, and extracted data in duplicate. We pooled data across studies using a random effects model. RESULTS: Our initial search yielded 720 studies, of which eight RCT ultimately met eligibility criteria and were included in this review. Somatostatin analogues significantly decreased the time to closure of fistulas compared to placebo {weighted mean difference (WMD)--6.37 days [95% confidence interval (CI) -8.33, -4.42]}. The duration of hospital stay was also significantly decreased with somatostatin analogue treatment [WMD--4.53 days (95% CI -8.29, -0.77)]. No difference in mortality was identified with somatostatin treatment [RR 0.87 (95% CI 0.49-1.55)]. CONCLUSIONS: Somatostatin analogues appear to decrease the duration of enterocutaneous fistulas and duration of hospital stay, but no mortality benefit was identified. The quality of evidence for outcomes in this review ranged from low to moderate. Future large, blinded, RCT would be useful in improving the confidence in the treatment effects identified in this systematic review and meta-analysis.
Authors: David Atkins; Dana Best; Peter A Briss; Martin Eccles; Yngve Falck-Ytter; Signe Flottorp; Gordon H Guyatt; Robin T Harbour; Margaret C Haugh; David Henry; Suzanne Hill; Roman Jaeschke; Gillian Leng; Alessandro Liberati; Nicola Magrini; James Mason; Philippa Middleton; Jacek Mrukowicz; Dianne O'Connell; Andrew D Oxman; Bob Phillips; Holger J Schünemann; Tessa Tan-Torres Edejer; Helena Varonen; Gunn E Vist; John W Williams; Stephanie Zaza Journal: BMJ Date: 2004-06-19
Authors: Gordon H Guyatt; Andrew D Oxman; Gunn Vist; Regina Kunz; Jan Brozek; Pablo Alonso-Coello; Victor Montori; Elie A Akl; Ben Djulbegovic; Yngve Falck-Ytter; Susan L Norris; John W Williams; David Atkins; Joerg Meerpohl; Holger J Schünemann Journal: J Clin Epidemiol Date: 2011-01-19 Impact factor: 6.437
Authors: J C Hernández-Aranda; B Gallo-Chico; L A Flores-Ramírez; R Avalos-Huante; F J Magos-Vázquez; E J Ramírez-Barba Journal: Nutr Hosp Date: 1996 Jul-Aug Impact factor: 1.057
Authors: A J Torres; J I Landa; M Moreno-Azcoita; J M Argüello; G Silecchia; J Castro; F Hernandez-Merlo; J M Jover; E Moreno-Gonzales; J L Balibrea Journal: Arch Surg Date: 1992-01
Authors: Aysegül Aksan; Karima Farrag; Irina Blumenstein; Oliver Schröder; Axel U Dignass; Jürgen Stein Journal: World J Gastroenterol Date: 2021-06-28 Impact factor: 5.742