Objective We searched the best available evidence to provide a basis for the medical or palliative surgical treatment of a patient suffering from terminal colon cancer, complicated by intestinal obstruction (malignant intestinal obstruction), so as to improve the patient’s quality of life and alleviate her clinical symptoms. Methods We formed the clinical question according to the PICO principle. We searched for systematic reviews and randomized controlled trials in The Cochrane Library (Issue 1, 2007), MEDLINE (PubMed, January 1950 to March 2007) and ACP Journal Club (January 1991 to March 2007), and evaluated the evidence retrieveds.?Results We found that both scopolamine and octreotide could alleviate nausea, vomiting and abdominal pain, but that octreotide was superior to scopolamine in reducing the secretion of gastric acid. Metoclopramide was effective in relieving fatigue, vomiting and intestinal obstruction associated with advanced cancer. A nasogastric tube may be used to drain the secretions before the administration of medical treatment, but long-term use tubes may make patients intolerable and induced side effects, such as necrosis of nasal mucous membrane and infection. At present, empirical palliative surgery was used for the management of malignant intestinal obstruction. This varied in different regions, and so the patients’ clinical condition should be taken into consideration. Being informed of the advantages and disadvantages of different treatment regimens, the patient and her family made the final decision.Conclusion The current evidence suggests that medical treatment can improve quality of life and alleviate clinical symptoms for a patient suffering from terminal colon cancer complicated with intestinal obstruction. However, the effect of palliative surgical treatment remains to be proved, and the decision about the appropriate treatment needs to consider the patients’ condition and the doctors’ clinical experiences.
Objective To evaluate the value of 99Tcm-Octreotide somatostatin receptor and 99Tcm-MIBI imaging in the detection of breast cancer. Methods 99Tcm-Octreotide and 99Tcm-MIBI imaging were performed in 26 patients with breast masses before operation. The scintigraphy results were analysed compared with pathologic study. Results The sensitivity, specificity and accuracy of 99Tcm-Octreotide scintigraphy for breast cancer were 94.4%, 87.5% and 92.3% respectively and those of 99Tcm-MIBI were 88.9%, 75.0% and 84.6% respectively. Significant difference was found between 99Tcm-Octreotide and 99Tcm-MIBI in both of specificity and accuracy (P＜0.05 and P＜0.01). The sensitivity, specificity and accuracy of 99Tcm-Octreotide scintigraphy in the detection of axillary lymph node involvement were 66.7%, 92.9% and 80.8% respectively. Those of 99Tcm-MIBI were 58.3%, 85.7% and 73.1% respectively. The specificity showed significant difference between 99Tcm-Octreotide and 99Tcm-MIBI (P＜0.01). Conclusion 99Tcm-Octreotide somatostatin receptor imaging may be superior to 99Tcm-MIBI in the detection of primary breast cancer and axillary lymph node involvement, and 99Tcm-Octreotide scintigraphy before operation is helpful in working out operative modality for patients.
ObjectiveTo study the effects and mechanism of Octreotide to inhibit the proliferation of human gastric cancer cells in vitro. MethodsHuman gastric cancer cell line SGC7901 was treated with Octreotide. Human fibroblast cell line HF and 5FU were used as control. MTT assay and fluorescent microscopy as well as flow cytometry were performed in this study. ResultsOctreotide inhibited the growth of SGC7901 in vitro within certain concentrations. The suppression was quantity dependent but did not occur when up to a certain concentration. There was no difference between Octreotide and 5FU in their inhibition on SGC7901. Octreotide had no effects on normal human fibroblast cell line HF. When SGC7901 was treated with Octreotide, the typical apoptotic bodies were identified by flow cytometry and fluorescent microscopy. ConclusionOctreotide can inhibit the proliferation of human gastric cancer cell line SGC7901 in vitro. The induction of apoptosis by Octreotide might be the primary mechanism.
To evaluate the role of octreotide in the treatment of severe acute pancreatitis (SAP). Seventy-six patients were divided into two groups (octreotide group, n＝38, control group, n＝38). All patients were treated by the same conservative regime. The octreotide group received octreotide. Results: The abdominal symptoms and signs, WBC count, serum amylase level, and volume of ascites were more effective controlled, with fewer complications occurred in octreotide group. Conclusion: Octreotide has a beneficial effect on the treatment of SAP, but the mechanism will be further investigated.
Objective To evaluate the effectiveness and safety of Octreotide combined with Ulinastatin for treating acute pancreatitis in China. Methods The databases such as CBM, VIP, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) from the date of their establishment to February 2011, and the relevant references of the included studies were also retrieved. Studie were screened, data were extracted, and the methodological quality was assessed by two reviewers independently. Meta-analyses were conducted by using RevMan 5.1 software. Results A total of 12 studies involving 1 023 participants were included. The results showed that compared with the group of routine therapies and the group of single administration of either Octreotide or Ulinastatin, the experimental group of Octreotide combined with Ulinastatin was superior in the following aspects with singnificant differences: the total effective rate (RR= 0.34, 95%CI 0.23 to 0.52), the remission time of abdominal pain and distention (SMD= –0.89, 95%CI –1.09 to –0.70), the remission time of signs of abdominal tenderness (SMD= –0.95, 95%CI –1.48 to –0.42), the average length of hospital stay (SMD= –1.10, 95%CI –1.58 to –0.63), the time for blood amylase returning to normal (SMD= –1.14, 95%CI –2.10 to –0.17) and the positive cases at the end of treatment (RR= 0.20, 95%CI 0.08 to 0.51), the time for urine amylase returning to normal (SMD= –0.86, 95%CI –1.04 to –0.68) and the positive cases at the end of treatment (RR= 0.27, 95%CI 0.12 to 0.63), the IL-6 level at the end of treatment (SMD= –2.25, 95%CI –4.39 to –0.11), the incidence rate of complications (RR= 0.39, 95%CI 0.28 to 0.55), the required rate of operation (RR= 0.41, 95%CI 0.24 to 0.69), and the mortality (RR= 0.43, 95%CI 0.29 to 0.64). But the experimental group showed a little longer time for blood calcium returning to normal without statistic difference (MD =0.15, 95%CI 0.05 to 0.26).Conclusion According to the domestic evidence, Octreotide combined with Ulinastatin for treating acute pancreatitis is superior to both the routine therapies and the singe administration of either Octreotide or Ulinastatin. It provides a new and prospective therapeutic method for AP. However, this conclusion has to be further verified by high quality, large scale and double blinded RCTs.
Objective To evaluate the efficacy and safety of prophylactic octreotide for preventing complications after pancreas transplantation. Methods We searched The Cochrane Library (Issue 1, 2008), PubMed (1970 to January 2008), EMbase (1974 to January 2008) and CBM (1978 to January 2008). Six studies concerning prophylactic octreotide in preventing complications after pancreas transplantation were retrieved. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently. Meta-analyses were done using The Cochrane Collaboration’s RevMan 4.2.10 software. Results Three RCTs, involving a total of 82 patients were included in the review. On the fifth postoperative day, the urinary amylase was significantly lower in patients in the octreotide group compared to the control group (SMD=–784.86, 95%CI –1464.24 to –105.49, P=0.02), and no significant difference was observed between the two groups in serum amylase (SMD=–12.26, 95%CI –56.53 to 32.06, P=0.59). No significant difference in the incidence of complications was noted between the two groups. The differences between the two groups in graft survival rate (90 days after operation) and patients’ 6-month survival rate were not statistically significant (RR=0.96, 95%CI 0.83 to 1.11, P=0.56; RR=1.17, 95%CI 0.86 to 1.58, P=0.32, respectively). As for safety, there were no reports of adverse effects of octreotide on CsA or FK506 absorption and no reports of other adverse reactions. Conclusion The evidence currently available shows that prophylactic octreotide is not capable of reducing dramatically the occurrence of pancreatitis, fistula, thrombosis and rejection after pancreas transplantation. And there is no obvious influence on graft survival rate and patient survival rate. Because the RCTs available for this systematic review are too small, further high-quality large-scale RCTs with long-term follow up are required to provide more reliable evidence.
Objective To evaluate the effectiveness and safety of somatostatin and the analogue-octreotide in preventing post-ERCP pancreatitis. Methods We searched Cochrane Clinical Trial Register （Issue 1, April, 2004 ）, MEDLINE （1966- April, 2004）, EMBASE （1985- April, 2004）, CBM disc （1970- April, 2004） and The Clinical Trial Register of Chinese Evidence-Based Medicine Center and handsearched the related journals to identify Randomized Controlled Trials （RCT）of somatostatin and octreotide in post-endoscopic retrograde chnlangiopancreatography pancreatitis（PEP）prevention. Systematic review was conducted using the method recommended by The Cochrane Collaboration. Results Thirty-one trials involving 4 728 patients undergoing ERCP were included. Meta-analysis showed that the incidence of post-ERCP pancreatitis [ OR 0.33, 95% CI 0. 20 to 0. 54; P =0. 000 01 ; NNT =13] was significantly reduced by somatostatin. Octreotide could only reduce the incidence of hyperamylasemia [ OR 0. 54, 95% CI 0. 38 to 0. 77 ; P =0. 000 7 ]. The inci- dence of PEP, severe PEP and post-ERCP abdominal pain could not be reduced by octreotide. Conclusions Somatostatin can prevent post-ERCP pancreatitis. Four trials are of high quality in the 12 included studies and the results are consistent with the sensitive-analysis, so it is credible to some extent. However, existing evidence does not support that octreotide can reduce the incidence of PEP, so it is not recommended for this indication. Sensitive-analysis even showed that octreotide could increase the incidence of PEP. Therefore, whether it is necessary to carry out further clinical trials should be considered with caution.
ObjectiveTo study the effect of octreotide on acute adhesive intestinal obstruction． MethodsFifty-two patients with adhesive intestinal obstruction from January 2009 to January 2011 in this hospital were divided into octreotide treatment group (n=28) and routine treatment group (n=24) according to the treatment methods. Apart from routine treatments, octreotide was administrated in the octreotide treatment group while traditional treatment in the routine treatment group．The effectiveness was observed and compared between two groups. ResultsThe cure rate of the octreotide treatment group was significantly higher than that of the routine treatment group (Plt;0.05). The anus exhausting and defecating time was earlier, hospitalization time was shorter, and gastrointestinal decompression of the treatment octreotide group as compared with the routine treatment group (Plt;0.05)． ConclusionConventional therapy combining with intravenous infusion of octreotide in patients with acute adhesive intestinal obstruction can improve the clinical symptoms and success rate of treatment．