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Background: Enterocutaneous fistulas are abnormal connections between the skin and gastrointestinal tract that most commonly occur following surgery. Somatostatin analogues have been used in their treatment. Our objective was to determine if somatostatin analogues shorten the time to closure of post-operative enterocutaneous fistuals 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 comparing somatostatin analogues to control in the treatment of post-operative 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 8 RCTs 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% 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 (Relative risk 0.87 [95% CI 0.49 to 1.55]).
Conclusion: Somatostatin analogues appear to decrease the duration of enterocutaneous fistuals and duration of hospital stay while no mortality benefit was identified. The quality of evidence for outcomes in this review ranged from low to moderate. Future, large, blinded randomized controlled trials would be useful in improving the confidence in the treatment effects identified in this systematic review and meta-analysis.