From the Guidelines
Octreotide, a somatostatin analogue, plays a role in the conservative management of chylothorax as an adjunctive therapy.
Conservative Management
- The goal of conservative management is to reduce the production of chyle and consequently flow through the thoracic duct.
- This can be achieved through dietary modifications, such as total parenteral nutrition or a nonfat diet, and adjunctive therapies like somatostatin (octreotide) 1.
- The success of conservative therapy approaches 50% in nonmalignant etiologies, but is only minimally beneficial in neoplastic etiologies 1.
Role of Octreotide
- Octreotide may be used to reduce chyle production, although the evidence remains scarce 1.
- The exact mechanism and efficacy of octreotide in chylothorax are not well defined, but it is thought to decrease gastrointestinal secretion and reduce chyle flow.
- Octreotide is typically used in conjunction with other conservative measures, such as thoracentesis and dietary modifications.
Clinical Decision Making
- The decision to use octreotide should be based on the underlying etiology of the chylothorax and the patient's response to initial conservative management 1.
- If conservative management, including octreotide, is unsuccessful, invasive treatments such as thoracic duct embolization or surgical ligation may be considered.
The FDA Drug Labels for octreotide (IV) do not address this question.
From the Research
Role of Octreotide in Chylothorax
- Octreotide, a somatostatin analogue, has been used as a potential therapeutic agent for treating chylothorax, with several case reports and series showing its safety and effectiveness in both children and adults 2, 3, 4, 5, 6.
- The mechanism of action of octreotide in chylothorax is attributed to its decelerating effect on lymph flow, although the exact mechanism is not well defined 3.
- Studies have shown that octreotide can reduce lymph drainage through the chest tube, with significant improvements in symptoms such as dyspnea, abdominal distention, and pain 2, 4.
- The use of octreotide has been reported to reduce the need for surgical interventions, with some studies showing a success rate of 87-90% in the use of octreotide as an adjunct to conservative management for the treatment of chylothorax 5.
- Octreotide has been used in various types of chylothorax, including postoperative, malignant, and congenital idiopathic chylothorax, with reported benefits in reduction of the volume and arrest of chylothorax 2, 4, 5, 6.
- The general consensus is for conservative management with octreotide to be instituted for 1 week before consideration of surgery, although some authors have advocated for a large volume chylothorax to be operated on sooner 5.
- The safety and efficacy of octreotide in neonates have not been evaluated in controlled clinical trials, although case series have reported its use in congenital idiopathic chylothorax with no adverse effects 6.