The use of octreotide in the treatment of chylothorax

Abstract

Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space. Chylothorax is a rare case and generally occurs after thoracic and cardiac procedures. Chylothorax causes respiratory and nutritional problems and a significant mortality rate. Good knowledge of the underlying pathophysiology enables early diagnosis and prevention of the chronic complications related to immunodeficiency and malnutrition. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax. In gastrointestinal tract, somatostatin and octreotide act on somatostatin receptors to reduce intestinal blood flow by vasoconstriction of the splanchnic vessels; decrease gastrointestinal motility; and inhibit gastric, pancreatic, and biliary secretions, thus reducing intestinal fat absorption and lymphatic flow in the thoracic duct. Octreotide is generally considered to be safe, with only occasional side effects. The side effects of octreotide are mainly related to its vasoconstrictive and antisecretory actions. The general consensus is for conservative management with octreotide to be instituted for 1 week before consideration of surgery. In case of either high flow rate chylothorax, especially after oesophageal surgery, or failure of conservative treatment with octreotide, operation is indicated.

Keywords

• Chylothorax,octreotide,treatment

Şilotoraksın tedavisinde oktreotidin kullanımı

Abstract

Şilotoraks plevral aralıkta lenfatik sıvının anormal birikimi olarak tanımlanır. Şilotoraks nadir bir durumdur ve genellikle torasik veya kardiyak işlemler sonrası ortaya çıkar. Şilotoraks solunumsal ve nütrisyonel problemlere ve anlamlı mortaliteye neden olur. Alttaki patofizyolojinin iyi bilinmesi erken tanıyı sağlar ve immün yetmezlik ve malnütrisyona bağlı kronik komplikasyonları önler. Octreotid lenfatik sıvı üretimini azaltan uzun etkili bir somatostatin analoğudur. Şilotoraks tedavisinde yeni bir yöntem olarak kullanılmaktadır. Gastrointestinal sistemde somatostatin ve octreotid, somatostatin reseptörleri üzerinden active olarak splenik damarların vazokonstrüksiyonu ile intestinal kan akımını azaltır. Ayrıca gastrointestinal motiliteyi, gastrik, pankreatik ve bilier sekresyonları azaltarak intestinal yağ emilimini azaltır ve sonuçta duktus torasikusta lenfatik akım azalır. Octreotid genel olarak güvenli kullanıma ve nadiren yan etkiye sahiptir. Octreotidin yan etkileri temel olarak vazokonstriktif ve sekresyonları inhibe edici etkisine bağlıdır. Genel konsensus cerrahiden önce bir hafta octreotid ile konservatif yaklaşımdır. Özellikle özefagus cerrahisi sonrası, şilotoraksın yüksek akımına sahip olduğu veya octreotid ile konservatif tedavinin yetersiz olduğu vakalarda operasyon endikedir.

Keywords

• Şilotoraks,oktreotide,tedavi

References

1. 1. Doerr CH, Allen MS, Nichols FC, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005;80:867–870.
2. 2. Chalret du Rieu M, Baulieux J, Rode A, Mabrut JY. Management of postoperative chylothorax. J Visc Surg 2011;148(5):346-52.
3. 3. Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg 2001;88(11):1442—8.
4. 4. Idris K, Sebastian M, Hefny AF, Khan FN, Abu-Zidan FM. Blunt traumatic tension chylothorax: case report and mini-review of the literature, World J Clin Cases 2016;4(11):380–384.
5. 5. Waikar HD, Kamalaneson P, Mohamad Zamri MS, Jayakrishnan AG. Chylothorax after off-pump coronary artery bypass graft surgery: Management strategy. Ann Card Anaesth 2018;21(3):300-303. 6. Pillay TG, Singh B. A review of traumatic chylothorax. Injury 2016;47:545–550.
6. 7. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 2009;104(1):1—8.
7. 8. Servelle M, Nogues C, Soulie J, Andrieux JB, Terhedebrugge R. Spontaneous, post-operative and traumatic chylothorax. J Cardiovasc Surg (Torino) 1980;21(4):475-86.
8. 9. Wasmuth-Pietzuch A, Hansmann M, Bartmann P, Heep A. Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr 2004;93(2):220-4.

9. 10. Dumont AE, Mayer DJ, Mulholland JH. The suppression of immunologic activity by diversion of thoracic duct lymph. Ann Surg 1964;160:373-83.
10. 11. Gómez-Caro Andrés A, Marrón Fernández C, Moradiellos Díez FJ, Díaz-Hellín Gude V, Pérez Antón JA, Martín de Nicolás JL. Octreotide for conservative management of postoperative chylothorax]. Arch Bronconeumol. 2004;40(10):473-5.
11. 12. Rimensberger PC, Muller-Schenker B, Kalangos A, Beghetti M. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 1998;66:253-2.
12. 13. Pratap U, Slavik Z, Ofoe VD, Onuzo O, Franklin RC. Octreotide to treat postoperative chylothorax after cardiac operations in children. Ann Thorac Surg 2001;72:1740-2.
13. 14. Guillem P, Billeret V, Houcke ML, Triboulet JP. Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine. Dis Esophagus 1999;12:155-6.
14. 15. Ohkura Y, Ueno M, Iizuka T, Udagawa H. Effectiveness of etilefrine regimen for chylothorax after esophagectomy with thoracic duct resection. Esophagus 2018;15(1):33-38.
15. 16. Ojima T, Nakamori M, Nakamura M, et al. A case of chylothorax appeared after surgery for esophageal cancer cured by administration of octreotide/etilefrine and injection of OK-432 into the pleural cavity. J Jpn Surg Assoc 2014;75:1547–50.
16. 17. Ohkura Y, Ueno M, Iizuka T, Haruta S, Tanaka T, Udagawa H. New Combined Medical Treatment With Etilefrine and Octreotide for Chylothorax After Esophagectomy: A Case Report and Review of the Literature. Medicine (Baltimore). 2015;94(49):2214.
17. 18. Karapınar K, Ulular Ö, Şahinalp Ş, Ersoy Ö, Özışık K, Yücel E. Effectiviness of somatostatin in the treatment of chylothorax: Case report. Bidder Tıp Bilimleri Dergisi 2010;2(2):28-30.
18. 19. Roehr CC, Jung A, Proquitte H, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med 2006;32:650-7.
19. 20. Helin RD, Angeles ST, Bhat R. Octreotide therapy for chylothorax in infants and children: a brief review. Pediatr Crit Care Med 2006;7:576-9.
20. 21. Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendick PJ. Octreotide in the treatment of thoracic duct injuries. Am Surg 2000;66:1165–7.
21. 22. Demos NJ, Kozel J, Scerbo JE. Somatostatin in the treatment of chylothorax. Chest 2001;119:964–6.
22. 23. Okumura H, Uchikado Y, Owaki T, Matsumoto M, Setoyama T, Kita Y et al. Post-esophagectomy chylothorax successfully treated with combination of thoracic duct clipping and octreotide administration. Esophagus 2012;9:29–32.
23. 24. Bryant AS, Minnich DJ, Wei B, Cerfolio RJ. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg 2014;98:232–7.
24. 25. Fujita T, Daiko H. Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy. World J Surg 2014;38:2039–45.
25. 26. Barbetakis N, Xenikakis T, Efstathiou A, Fessatidis I. Successful octreotide treatment of chylothorax following coronary artery bypass grafting procedure. A case report and review of the literature. Hellenic J Cardiol 2006;47:118–22.
26. 27. Gabbieri D, Bavutti L, Zaca F, Turinetto B, Ghidoni I. Conservative treatment of post-operative chylothorax with octreotide. Ital Heart J 2004;5:479–82.
27. 28. Kilic D, Sahin E, Gulcan O, Bolat B, Turkoz R, Hatipoglu A. Octreotide for treating chylothorax after cardiac surgery. Tex Heart Inst J 2005;32:437–9.
28. 29. Chamberlain MRC. Late presentation of tension chylothorax following blunt chest trauma. Eur J Cardiothorac Surg 2000;18:357–359.
29. 30. Marts BC, Naunheim KS, Fiore AC, Pennington DG. Conservative versus surgical management of chylothorax, Am J Surg 1992;164:532–534.
30. 31. Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 2007;32(2):362-9.