Medical Management of Inoperable Malignant Bowel Obstruction

Abstract

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.

Inoperable Bowel Obstruction in Ovarian Cancer: Prevalence, Impact and Management Challenges

“…Increased endoluminal pressure, stasis and ischemia promote bacterial translocation from the intestinal wall into the lymphatic and systemic circulation, which may result in sepsis, gangrene and perforation. 8 , 9 …”

“…MBO manifests insidiously and results in variety of symptoms such as nausea, vomiting, abdominal cramping, distension, bloating, and decreased passage of flatus or stool elimination. 4 , 8 , 9 …”

“…Hyoscine butylbromide may be used for the treatment of inoperable MBO, but there is less evidence to support its use. 9 Obita et al concluded in their systematic review that somatostatin analogues (eg, octreotide) are more effective than hyoscine butylbromide in decreasing continuous pain in 2 studies with high Cochrane risk of bias. 37 , 84 , 87 Another study, however, did not show the same findings.…”

Brazilian Society of Surgical Oncology guidelines for malignant bowel obstruction management

“…Conservative measures include bowel rest and drug therapy. Anticholinergic drugs, antisecretory drugs such as somatostatin analogs, neuroleptics, glucocorticoids, and opioids are the essential drugs that inhibit inflammation and decrease intraluminal secretion volume, prevent painful peristaltic movements, and promote gastric emptying, reducing pain and cramps, nausea, and vomiting in up to 70% of the cases 5,9,10 …”

“…The obstruction can be partial or complete. Depending on the degree of lumen occlusion, patients with an MBO will present with pain due to abdominal distension, cramps, nausea and vomiting, cessation of gas and feces elimination, and progressive inability to eat 4,5 …”