A Meta-analysis of Outcomes Following Use of Somatostatin and Its Analogues for the Management of Enterocutaneous Fistulas

Objective: Several randomized control trials (RCTs) have compared somatostatin and its analogues versus a control group in patients with enterocutaneous fistulas (ECF). This study meta-analyzes the literature and establishes whether it shows a beneficial effect on ECF closure. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane, and PubMed databases according to PRISMA guidelines. Seventy-nine articles were screened. Nine RCTs met the inclusion criteria. Statistical analyses were performed using Review Manager 5.1. Results: Somatostatin analogues versus control Number of fistula closed: A significant number of ECF closed in the somatostatin analogue group compared to control group, P = 0.002. Time to closure: ECF closed significantly faster with somatostatin analogues compared to controls, P < 0.0001. Mortality: No significant difference between somatostatin analogues and controls, P = 0.68. Somatostatin versus control Number of fistula closed: A significant number of ECF closed with somatostatin as compared to control, P = 0.04. Time to closure: ECF closed significantly faster with somatostatin than controls, P < 0.00001. Mortality: No significant difference between somatostatin and controls, P = 0.63 Conclusions: Somatostatin and octreotide increase the likelihood of fistula closure. Both are beneficial in reducing the time to fistula closure. Neither has an effect on mortality. The risk ratio (RR) for somatostatin was higher than the RR for analogues. This may suggest that somatostatin could be better than analogues in relation to the number of fistulas closed and time to closure. Further studies are required to corroborate these apparent findings.