Effects on absorptive and motor functions of sandostatin LAR® depot in management of short bowel syndrome (SBS)

Abstract

The short-acting somatostatin analog, octreotide, retards gastrointestinal transit and reduces fluid requirements in patients with SBS. Aim: To assess the effects of long-acting octreotide depot (Sandostatin LAR® Depot) on body weight, stool water and electrolyte losses, fecal fat excretion, and gastrointestinal transit in patients with SBS. Methods: A 15-week prospective study was performed in 8 patients with SBS who had been TPNdependent for a mean of 11.9 years (range 1.5-22 yr). After initial balance studies, all patients received i.m. injection of Sandostatin LAR® Depot, 20 mg, given at baseline and after 3,7, and 11 weeks. The final injection was given 4 weeks prior to repeat balance studies. Preand post-treatment changes in body weight, stool and urine, and scintigraphic gastric and small bowel transit (using 99mTc_sulfur colloid egg) were compared by paired t-tests, Results: Eight patients with SBS (5F, 3M; mean age 52, range 37-72 yr) with <200 ern small bowel were evaluated. The underlying diagnoses were: Crohn's disease (n=6), intestinal ischemia (n= 1), carcinoid syndrome (n=I); 3 had colon in continuity. Sandostatin LAR® Depot significantly prolonged small bowel transit (fig, 135±47 preto 172::':50 min post-treatment; p=O.03). No significant changes (table, mean±SEM) in body weight, urine volume, stool weight, fecal fat excretion, stool sodium and potassium excretion, or gastric emptying were demonstrable in SBS with or without colon in continuity. Conclusion: Sandostatin LAR® Depot for 15 weeks resulted in significant prolongation of small bowel transit in SBS patients; amelioration of stool absorption of water and macronutrients (fat and electrolytes) may require a higher dose or longer treatment with Sandostatin LAR® Depot. 883