Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management

Malignant bowel obstruction (MBO) is a common manifestation in patients with advanced intra-abdominal malignancy. It is especially common with bowel or gynecological cancers and produces distressing symptoms, including nausea, vomiting, and pain. Medical management options are less effective than decompressive strategies for symptom control. Surgery is the gold-standard treatment but is unsuitable for most patients with high complication rates. Consensus guidelines recommend nonsurgical management with a venting gastrostomy in those unsuitable for surgery or for whom medical management is ineffective. The aim of this systematic review is to establish the safety and efficacy of percutaneous venting gastrostomy in relieving symptoms of MBO. Twenty-five studies were included in this review comprising 1194 patients. Gastrostomy insertion was successful at first attempt in 91% of cases and reduction in symptoms of nausea and vomiting was reported in 92% of cases. Mean survival following the procedure ranged from 35 to 147 days. Major complications were rare, with most complications classed as minor wound infections or leakage of fluid around the tube. Studies suggest that the presence of ascites is not an absolute contraindication to the insertion of percutaneous venting gastrostomy in patients with MBO; however, these studies lack longitudinal outcomes and complication rates related to this. However, it is reasonable to suggest that ascitic drainage is performed to reduce potential complications. There is a relative lack of good quality robust data on the utilization of percutaneous venting gastrostomy in MBO, but overall, the combination of being a safe and efficacious procedure alongside the known complication profile suggests that it should be considered a suitable management option.

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A REGIONAL RE-AUDIT OF THE SYMPTOMATIC MANAGEMENT OF NAUSEA & VOMITING IN THE MEDICAL MANAGEMENT OF MALIGNANT BOWEL OBSTRUCTION

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2014-000654.194 ◽

2014 ◽

Vol 4 (Suppl 1) ◽

pp. A68.2-A68

Author(s):

Timothy Jackson ◽

David Waterman ◽

Ashique Ahamed ◽

Rebecca Lennon ◽

Julie Suman ◽

...

Keyword(s):

Bowel Obstruction ◽

Medical Management ◽

Malignant Bowel Obstruction ◽

Symptomatic Management

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Medical Management of Inoperable Malignant Bowel Obstruction

Annals of Pharmacotherapy ◽

10.1177/1060028020979773 ◽

2020 ◽

pp. 106002802097977

Author(s):

Xiaoyan Huang ◽

Jing Xue ◽

Min Gao ◽

Qiyuan Qin ◽

Tenghui Ma ◽

...

Keyword(s):

Quality Of Life ◽

Adverse Effects ◽

Bowel Obstruction ◽

Medical Management ◽

Case Reports ◽

Somatostatin Analogs ◽

Clinical Approach ◽

Malignant Bowel Obstruction ◽

Anti Inflammatory

Objective: To review medical management of inoperable malignant bowel obstruction. Data Sources: A literature review using PubMed and MEDLINE databases searching malignant bowel obstruction, etiology, types, pathophysiology, medical, antisecretory, anti-inflammatory, antiemetic drugs, analgesics, promotion of emptying, prevention of infection, anticholinergics, somatostatin analogs, gastric antisecretory drugs, prokinetic agents, glucocorticoid, opioid analgesics, antibiotics, enema, and adverse effects. Study Selection and Data Extraction: Randomized or observational studies, cohorts, case reports, or reviews written in English between 1983 and November 2020 were evaluated. Data Synthesis: Malignant bowel obstruction (MBO) commonly occurs in patients with advanced or recurrent malignancies and severely affects the quality of life and survival of patients. Its management remains complex and variable. Medical management is the cornerstone of MBO treatment, with the goal of reducing distressing symptoms and optimizing quality of life. Until now, there has been neither a standard clinical approach nor registered medications to treat patients with inoperable MBO. Relevance to Patient Care and Clinical Practice: This review provides information on the etiology, type and pathophysiology, and medical treatment of MBO and related adverse reactions of the drugs commonly used, which can greatly assist clinicians in making clinical decisions when treating MBO. Conclusions: Published research shows that medical management of MBO mainly consists of antisecretory, anti-inflammatory strategies, controlling vomiting and pain, promoting emptying, preventing infection, and combination therapy. Being knowledgeable about the most current treatment options, the related adverse effects, and the evidence supporting different practices is critical for clinicians to provide individualized medical therapy for MBO patients.

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The Medical Management of Malignant Bowel Obstruction

Cancer Chemotherapy and Selective Drug Development ◽

10.1007/978-1-4613-3837-6_26 ◽

1984 ◽

pp. 183-188

Author(s):

M. J. Baines

Keyword(s):

Bowel Obstruction ◽

Medical Management ◽

Malignant Bowel Obstruction

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Medical management of malignant bowel obstruction: our center experience

Annals of Oncology ◽

10.1093/annonc/mdx422.041 ◽

2017 ◽

Vol 28 ◽

pp. vi15

Author(s):

G. Astara ◽

E. Lai ◽

S. Tolu ◽

R. Mascia ◽

V. Impera ◽

...

Keyword(s):

Bowel Obstruction ◽

Medical Management ◽

Malignant Bowel Obstruction

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Regional audit on the symptomatic management of nausea & vomiting in the medical management of malignant bowel obstruction

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2012-000196.193 ◽

2012 ◽

Vol 2 (Suppl 1) ◽

pp. A66.2-A66

Author(s):

Elizabeth O'Brien ◽

Laura Edwards ◽

Aaron Sutherland ◽

Kath Mitchell ◽

Maxine Concannon ◽

...

Keyword(s):

Bowel Obstruction ◽

Medical Management ◽

Malignant Bowel Obstruction ◽

Symptomatic Management

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Palliative medical management of inoperable malignant bowel obstruction with “triple therapy”: Dexamethasone, octreotide, and metoclopramide at a comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.125 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 125-125

Author(s):

Winston Wey ◽

Moeena Mian ◽

Rebecca Calabrese ◽

Eric Hansen ◽

Michelle Walter ◽

...

Keyword(s):

Drug Therapy ◽

Triple Therapy ◽

Bowel Obstruction ◽

Medical Management ◽

Oral Intake ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Malignant Bowel Obstruction ◽

Advanced Malignancy ◽

Endoscopic Gastrostomy

125 Background: Malignant bowel obstruction (MBO) is a complication of advanced malignancy. For inoperable patients, symptoms are often treated using analgesics, anticholinergics, and anti-emetics. There are, however, few published guidelines or algorithms for the medical management of MBO. Therefore, the objective was to measure the effect of the combination of dexamethasone, octreotide, and metoclopramide (“triple therapy”) in patients with MBO, compared to patients who received none of the three medications (“no drug therapy”). Methods: A retrospective cohort study was done of patients with malignant bowel obstruction admitted between 1/1/2015 to 12/31/2018. The outcome measures were a patient having de-obstruction (defined as toleration of oral intake and resolution of nausea and vomiting), as well as time to de-obstruction. Results: Medical staff identified 34 patients who received triple therapy and 34 patients who received no drug therapy. Patients who received triple therapy were more likely to reach de-obstruction, compared to patients who had no drug therapy (OR: 9.02 [1.43, 56.99], p=0.0194), after adjusting for related covariates (i.e. length of stay and percutaneous endoscopic gastrostomy [PEG] placement). Patients who reached de-obstruction in the triple therapy arm, however, took longer to reach de-obstruction than those in the no drug therapy arm (5.4 days versus 3.4 days, p=0.045). Conclusions: Triple drug therapy with dexamethasone, octreotide, and metoclopramide leads to higher rates of de-obstruction in patients with inoperable MBO, compared to patients who received none of the three drugs, though time to de-obstruction is longer.

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