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The effect of octreotide on gastric emptying at a dosage used to prevent complications after pancreatic surgery: a randomised, placebo controlled study in volunteers
  1. M I van Berge Henegouwena,
  2. Th M van Gulika,
  3. L M A Akkermansb,
  4. J B M J Jansenc,
  5. D J Goumaa
  1. aDepartment of Surgery, Academic Medical Centre, University of Amsterdam, bDepartment of Surgery, University Hospital, Utrecht, cDepartment of Gastroenterology, Academic Hospital, Nijmegen, The Netherlands
  1. Dr M I van Berge Henegouwen, Department of Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

Abstract

Background—Octreotide is used in many centres to prevent complications after pancreatic surgery. Delayed gastric emptying is a another complication occurring in around 30% of patients after pancreatoduodenectomy (PD) and causes prolonged hospital stay. The influence of octreotide on this complication is doubtful.

Aims—To assess the effect of octreotide, at the clinical dosage used after pancreatic surgery, on gastric emptying in healthy volunteers.

Subjects and methods—Eight healthy male volunteers (mean age 22.5 years) participated in this double blind, placebo controlled study. On day 1 subjects received 100 μg of octreotide or placebo subcutaneously, three times daily and on day 2, one hour after the fourth injection, gastric emptying, postprandial cholecystokinin (CCK) release, and mouth to caecum transit time (MCTT) were measured. This protocol was repeated after one week, in a crossover design. On the test day subjects received a liquid test meal (1.57 MJ/300 ml) and gastric emptying measurements were performed with applied potential tomography, a non-invasive, validated technique which measures gastric emptying through impedance differences. From the gastric emptying curves, lag time, t50, and postlag emptying rate were measured. MCTT was measured using the hydrogen breath test.

Results—Lag time decreased from 29.6 (6.3) (mean (SEM)) to 12.2 (4.6) minutes (p<0.05) during octreotide treatment; t50 decreased from 87.8 (12.0) to 47.5 (8.2) minutes (p<0.02) and there was a trend towards an increased postlag emptying rate (0.8 to 1.6% per minute; p=0.07). MCTT increased from 150 (12.7) to 229 (17.9) minutes during octreotide treatment (p<0.01). Octreotide suppressed postprandial CCK release (p<0.05).

Conclusions—MCTT was delayed by octreotide, suggesting impairment of small bowel transit. Octreotide administered at the clinical dosage for pancreatic surgery accelerates gastric emptying, mainly by shortening the lag time. Suppression of postprandial CCK release may be involved in this process. Octreotide administration is therefore not a contributing factor in the pathogenesis of delayed postoperative gastric emptying after PD and might even play a role in preventing this complication.

  • octreotide
  • gastric emptying
  • cholecystokinin
  • intestinal transit
  • pancreatic surgery
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