Is it safe to administer jejunal (jejunum) tube feeds to a patient on Octreotide (somatostatin analogue)?

Jejunal Tube Feeds in Patients on Octreotide

Jejunal tube feeds can be administered to patients on octreotide, but continuous infusion rather than bolus feeding is required due to octreotide's effects on intestinal motility and secretions. 1

Mechanism of Concern

Octreotide (a somatostatin analog) affects the gastrointestinal tract in several ways that impact enteral feeding:

• Decreases gastric, biliary, and pancreatic secretions
• Inhibits secretagogue-induced water and electrolyte secretion in the jejunum
• Stimulates sodium and chloride absorption in the ileum
• Decreases intestinal motility
• Inhibits the release of hormones that contribute to diarrhea (e.g., VIP, GIP, gastrin) 1

These effects, while beneficial for reducing high-output ostomies, can potentially interfere with nutrient absorption when administering jejunal feeds.

Recommended Approach for Jejunal Feeding with Octreotide

1. Feeding Method:

   • Use continuous infusion rather than bolus feeding
   • Bolus delivery into the jejunum can cause a "dumping" type syndrome and should be avoided 1
   • Continuous infusion helps prevent dumping and manages diarrhea better

2. Monitoring Requirements:

   • Monitor stoma output volume, weight, urine output, and serum electrolytes daily
   • Assess for signs of dehydration and potential fluid retention
   • Evaluate nutrient absorption and adjust feeding rates accordingly 2

3. Feed Selection:

   • Choose feeds based on the patient's nutritional requirements
   • Consider any abnormalities of gastrointestinal absorption or motility
   • Adjust for any system abnormalities (renal or liver failure) 1

Special Considerations

Timing of Octreotide Administration

• For patients on both jejunal feeds and octreotide, administer octreotide before meals (or feeding increases) as intestinal output typically rises after eating 2
• Initial dose of subcutaneous octreotide is typically 50 mcg twice daily 2

Potential Complications

• Octreotide may reduce fat absorption in some patients
• Some patients with high outputs may experience significant fluid retention when starting octreotide treatment 1
• Regular assessment of feed tolerance is essential

Clinical Evidence

Studies have shown that octreotide effectively reduces ileostomy diarrhea and large-volume jejunostomy output 1, 3. In one study, octreotide allowed for a daily reduction in intravenous fluid requirements of 1-1.5L in patients with short bowel syndrome 3.

Additionally, octreotide has been shown to improve enteral tolerance in total parenteral nutrition (TPN)-dependent children with chronic intestinal pseudo-obstruction, with 44% of patients showing significant response to therapy 4.

Pitfalls to Avoid

1. Using bolus feeding in the jejunum when on octreotide (can cause dumping syndrome)
2. Failing to monitor for fluid retention when initiating octreotide
3. Not adjusting parenteral support accordingly when octreotide reduces fluid requirements
4. Overlooking potential interference with the physiological process of intestinal adaptation during long-term use 1

By following these guidelines and maintaining careful monitoring, jejunal tube feeds can be safely administered to patients on octreotide therapy.