Conservative treatment of acute pancreatitis: the use of somatostatin.

The aim of the medical treatment of acute pancreatitis is to rest the gland and to reduce complication and mortality rates. The effect of various treatment modalities on the course and outcome of acute pancreatitis have been disappointing. This review critically considers the results of reported therapeutic trials and our own unpublished data of somatostatin and its long-acting synthetic analogue, octreotide, in acute pancreatitis. It is concluded that somatostatin is a promising drug. It reduces pancreatic enzyme secretion, the clinical need for analgesic drug administration, and the local complication rate, and shortens hospitalization. However, its effect on mortality rates is questionable. It is suggested that large-scale, carefully designed studies of somatostatin are needed to evaluate the beneficial effect of this drug on the course and outcome of acute pancreatitis. Since most of the trials included pancreatitis of various etiologies, it is also suggested that cases of acute biliary pancreatitis should be excluded or evaluated separately, as these patients are best treated by endoscopic sphincterotomy.