Lanreotide in the prevention and management of high-output ileostomy after colorectal cancer surgery

Figures & data

Table 1. Risk factors for developing high-output stoma[17–20].

Age >65 years

Hypertension

Intraabdominal sepsis

Enteric infection

Partial or intermittent bowel obstruction

Low intestine absorptive surface (due to bowel resection, Crohn’s disease, etc.)

Administration of prokinetics or metformin

Withdrawal of steroids or opiates

Conditions associated to electrolyte and fluid imbalances (e.g. thyroid/parathyroid disorders, renal disease, alcohol abuse, cirrhosis)

Chemotherapy treatment with known risk of diarrhea and intestinal mucositis

Table 2. Management of high-output ileostomy.

Identify potential causes and treat them, if any

Intraabdominal sepsis

Partial/intermittent bowel obstruction

Recurrent bowel disease (e.g. Crohn’s disease)

Medication/drugs (e.g. prokinetics, metformin, withdrawal of steroids, cytotoxic agents)

Enteric infection (e.g. Clostridium, Salmonella)

Monitor and reduce fluid and electrolyte^a losses

Restrict oral intake of hypo- and hypertonic fluids to 0.5–1 L

Implement an oral glucose/electrolyte solution containing >90 mmol/L sodium (e.g. Saint Mark’s solution: 20 g glucose, 3.5 g sodium chloride, and 2.5 g sodium bicarbonate in 1 L water; ≥1 L solution per 24 h)

Implement drug therapy

^ Antimotility drugs (e.g. loperamide, codeine phosphate)

^ Drugs that inhibit gastric acid secretion (e.g. omeprazole, cimetidine)

^ Drugs that inhibit broad gastrointestinal secretions(e.g. lanreotide, octreotide)

Implement parenteral/intravenous therapy to maintain hydration andelectrolyte balance

Monitor renal function and treat any alteration

Monitor nutritional status and support it, if needed

^a Magnesium, calcium, phosphorus, potassium, and sodium should be closely monitored.