Protocol for the Treatment of Malignant Inoperable Bowel Obstruction: A Prospective Study of 80 Cases at Grenoble University Hospital Center

Abstract

A prospective protocol for treatment of malignant inoperable bowel obstruction was implemented at Grenoble University Hospital Center for 4 years. All 80 episodes of obstruction resulted from peritoneal carcinomatosis and none could expect another treatment cure. The protocol comprised three successive stages. Stage I included treatment for 5 days with a corticosteroid, antiemetic, anticholinergic, and analgesic. Stage II provided a somatostatin analogue if vomiting persisted. After 3 days, Stage III provided a venting gastrostomy. Obstruction relief with symptom control was obtained by medical treatment in 29 cases and symptom control occurred alone in an additional 32 cases. Ten patients were relieved by venting gastrostomy. Symptom control without permanent nasogastric tube (NGT) placement occurred in 72 episodes (90%). Eight patients with refractory vomiting were obliged to continue the NGT until death. Fifty-eight obstruction episodes (73%) were controlled in 10 days or less. Median time before gastrostomy was 17 days. Median survival was 31 days. This series suggests that a staged protocol for the treatment of inoperable malignant bowel obstruction is highly effective in relieving symptoms. A subgroup experiences relief of obstruction using this approach.

Predictors of survival in patients with non‐curative stage IV cancer and malignant bowel obstruction

“…Median survival for patients with an ECOG score of 0-1 (n ¼ 15) was 222 days, which is much higher than the predicted 1-to 3-month survival that is expected with a diagnosis of MBO [4][5][6][7][8][9]. However, perhaps the most important information that this study has generated is the attenuated survival for patients with an ECOG score of 2 despite the fact that 7/9 patients received further treatment.…”

“…MBO occurs in up to 15% of patients admitted to palliative care wards and in 10-28% of patients diagnosed with colorectal cancer and management can be clinically challenging [2] [3]. Survival is generally poor with a reported median survival of 1-3 months, particularly in the setting of carcinomatosis [4][5][6][7][8][9]. However, there is a population of patients with MBO who can benefit from palliative chemotherapy and surgery and have a prolonged survival of more than a year [10] [11].Consequently, clinical decision making and treatment recommendations in patients with MBO is important and is dependent upon the development of accurate predictors of survival [12].…”

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…Decompression and reduction in secretions may also assist with pain. In patients with inoperable malignant bowel obstruction and decompressive nasogastric tube, both hyoscine butylbromide and the somatostatin analog octreotide reduced both continuous and colicky pain intensity (Ripamonti et For malignant bowel obstruction with peritoneal carcinomatosis, treatment according to a staged protocol with analgesic, antiemetic, anticholinergic and corticosteroid as initial therapy (Stage 1), followed by a somatostatin analog for persistent vomiting (Stage 2) and then venting gastrostomy (Stage 3) was highly effective in relieving symptoms and avoiding permanent nasogastric tube, in one hospital centre (Laval et al, 2006 Level IV).…”

Role of Steroids in Malignant Bowel Obstruction

“…He founded that out of 15 patients, 14 had recovery of intestinal transit within 1 to 5 days due to synergistic effect and vomiting resolved within 24 hours. 19 Laval et al 20 observed that relief of MBO occurred with steroids along with antiemetic anticholinergic and analgesic when given for 5 days. They reported that 25 patients (31%) had symptomatic control without obstruction relief and 25 patients (31%) had resolution of MBO out of total 80 cases.…”

“…They reported that 25 patients (31%) had symptomatic control without obstruction relief and 25 patients (31%) had resolution of MBO out of total 80 cases. 20 The dose of methylprednisolone use was 1-4 mg/kg/24 hours for 1hr intravenous infusion in the morning for 5 days or subcutaneously in 2 fractions in 2 different sites.…”