DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20214044

Large bowel obstruction in palliative care: overview, management and monitoring

Noora O. Rahimuddin, Fatma A. Al-Fodari, Laila M. Yatimi, Ahmed M. Alsaffar, Basmah K. Kadir, Tariq H. Alrazhi, Waleed A. Alzaylaee, Mohammad S. Almarri, Sameer S. Alshelahi, Mohammad A. Almuhaiteeb, Hamad A. Alhamad

Abstract


Patients with pelvic and abdominal cancers usually present with bowel obstruction, especially peritoneal, colorectal, and pancreatic carcinomatosis. A poor prognosis has been reported for patients that suffer from gastrointestinal bowel obstruction secondary to later stage carcinomatosis, although maximal treatment approaches might have been administered. In this context, these patients are suggested to survive for only a few weeks to months, and parenteral nutrition did not enhance the outcomes in these situations. Medical treatment includes the administration of corticosteroids, opioids, anticholinergics, octreotide, and anti-emetics, while surgical outcomes might be more efficacious with more favorable clinical outcomes. However, these operations have been reported with multiple complications that might worsen the prognosis. Stent application is another non-surgical modality with fewer adverse events. Nevertheless, evidence regarding its superiority over the surgical approaches is conflicting among the different studies in the literature. Accordingly, further investigations are still needed for adequate validation.


Keywords


Palliative care, Bowel obstruction, Management, Evaluation, Prognosis

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References


Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK. Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg. 2009;33(6):1281-6.

DeBernardo R. Surgical management of malignant bowel obstruction: strategies toward palliation of patients with advanced cancer. Curr Oncol Rep. 2009;11(4):287-92.

Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth C. Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg. 1998;85(9):1260-5.

Hanks G, Cherny NI, Christakis NA, Kaasa S. Oxford textbook of palliative medicine. Oxford university press. 2011.

Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life. BMJ (Clinical research ed). 2003;326(7379):30-4.

Wenrich MD, Curtis JR, Shannon SE, Carline JD, Ambrozy DM, Ramsey PG. Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death. Arch Int Med. 2001;161(6):868-74.

Soriano A, Davis MP. Malignant bowel obstruction: individualized treatment near the end of life. Cleveland Clinic J Med. 2011;78(3):197-206.

Kolomainen DF, Barton DP. Surgical management of bowel obstruction in gynaecological malignancies. Current opinion in supportive and palliative care. 2011;5(1):55-9.

Chakraborty A, Selby D, Gardiner K, Myers J, Moravan V, Wright F. Malignant bowel obstruction: natural history of a heterogeneous patient population followed prospectively over two years. J Pain Symptom Management. 2011;41(2):412-20.

Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer (Oxford, England: 1990). 2008;44(8):1105-15.

Mohammed A, Ghanem H, Saify A. Gastrointestinal obstruction in palliative care: A review. Forum Clin Oncol. 2015;6:1-5.

Tuca A, Guell E, Martinez-Losada E, Codorniu N. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer management and research. 2012;4:159-69.

Ripamonti C, Bruera E. Palliative management of malignant bowel obstruction. Int J Gynecol Cancer. 2002;12(2):135-43.

Roeland E, von Gunten CF. Current concepts in malignant bowel obstruction management. Curr Oncol Rep. 2009;11(4):298-303.

Mercadante S, Ferrera P, Villari P, Marrazzo A. Aggressive pharmacological treatment for reversing malignant bowel obstruction. J Pain Symptom Management. 2004;28(4):412-6.

Winner M, Mooney SJ, Hershman DL. Management and outcomes of bowel obstruction in patients with stage IV colon cancer: a population-based cohort study. Dis Colon Rectum. 2013;56(7):834-43.

White SI, Abdool SI, Frenkiel B, Braun WV. Management of malignant left-sided large bowel obstruction: a comparison between colonic stents and surgery. ANZ J Surg. 2011;81(4):257-60.

Jaffe T, Thompson WM. Large-Bowel Obstruction in the Adult: Classic Radiographic and CT Findings, Etiology, and Mimics. Radiology. 2015;275(3):651-63.

Godfrey EM, Addley HC, Shaw AS. The use of computed tomography in the detection and characterisation of large bowel obstruction. N Zealand Med J. 2009;122(1305):57-73.

Beattie GC, Peters RT, Guy S, Mendelson RM. Computed tomography in the assessment of suspected large bowel obstruction. ANZ J Surg. 2007;77(3):160-5.

Hsu J, Sevak S. Management of Malignant Large-Bowel Obstruction. Dis Colon Rectum. 2019;62(9):1028-30.

Doyle D, Hanks GW, Mac Donald N. Oxford textbook of palliative medicine. Oxford University Press. 1999.

Foo CC, Poon JT, Law WL. Self-expanding metallic stents for acute left-sided large-bowel obstruction: a review of 130 patients. Colorectal Dis. 2011;13(5):549-54.

Frago R, Ramirez E, Millan M, Kreisler E, del Valle E, Biondo S. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207(1):127-38.

Badgwell BD, Contreras C, Askew R, Krouse R, Feig B, Cormier JN. Radiographic and clinical factors associated with improved outcomes in advanced cancer patients with bowel obstruction. J Palliative Med. 2011;14(9):990-6.

Badgwell BD, Smith K, Liu P, Bruera E, Curley SA, Cormier JN. Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation. Support Care Cancer. 2009;17(6):727-34.

Centeno C, Robinson C, Noguera-Tejedor A, Arantzamendi M, Echarri F, Pereira J. Palliative care and the arts: vehicles to introduce medical students to patient-centred decision-making and the art of caring. BMC Med Educ. 2017;17(1):257.

Ripamonti C, Twycross R, Baines M. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001;9(4):223-33.

Pfister DG, Ang KK, Brizel DM, et al. Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines. J Nat Comprehens Cancer Network. 2013;11(8):917-23.

Thieu H, Bach Dat B, Nam NH. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva Medica. 2020;111(5):498-501.

Glare PA, Sinclair CT. Palliative medicine review: prognostication. J Palliative Med. 2008;11(1):84-103.

Laval G, Rousselot H, Toussaint-Martel S, et al. SALTO: a randomized, multicenter study assessing octreotide LAR in inoperable bowel obstruction. Bull du cancer. 2012;99(2):1-9.

Mystakidou K, Befon S, Liossi C, Vlachos L. Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlorpromazine in the treatment of emesis associated with far advanced cancer. Cancer. 1998;83(6):1214-23.

Davis MP, Hallerberg G. A systematic review of the treatment of nausea and/or vomiting in cancer unrelated to chemotherapy or radiation. J Pain Symptom Management. 2010;39(4):756-67.

Murakami H, Matsumoto H, Nakamura M, Hirai T, Yamaguchi Y. Octreotide acetate-steroid combination therapy for malignant gastrointestinal obstruction. Anticancer Res. 2013;33(12):5557-60.

Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Systemat Rev. 2000;2000(2):CD001219.

Nguyen TM, Huan VT, Reda A. Clinical features and outcomes of neonatal dengue at the Children's Hospital 1, Ho Chi Minh, Vietnam. J Clin Virol. 2021;138:104758.

Thaker DA, Stafford B, Gaffney L. Palliative Management of Malignant Bowel Obstruction in Terminally Ill Patient. Indian J Palliative Care. 2010;16:97-100.

Franke AJ, Iqbal A, Starr JS, Nair RM, GeorgeJr TJ. Management of Malignant Bowel Obstruction Associated With GI Cancers. J Oncol Pract. 2017;13(7):426-34.

Ye GY, Cui Z, Chen L, Zhong M. Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction: a systematic review and meta-analysis. World J Gastroenterol. 2012;18(39):5608-15.

Cennamo V, Luigiano C, Coccolini F. Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction. Int J Colorectal Dis. 2013;28(6):855-63.

Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc. 2012;26(1):110-9.

Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg. 2012;99(4):469-76.

Cirocchi R, Farinella E, Trastulli S. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol. 2013;22(1):14-21.

Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246(1):24-30.