Home parenteral nutrition for people with inoperable malignant bowel obstruction

Sowerbutts, Anne Marie; Lal, Simon; Todd, Chris; Jayson, Gordon C; Teubner, Antje; Raftery, Anne-Marie; Sutton, Eileen; Sremanakova, Jana; Burden, Sorrel

doi:10.1002/14651858.cd012812

Cited by 17 publications

(18 citation statements)

References 26 publications

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“…The study is part of a larger project investigating HPN in women with ovarian cancer, which involved interviewing patients, relatives and healthcare professionals (9,(17)(18)(19)(20) this report focusses on patients' relationship with food whilst being on parenteral nutrition. Participants had advanced ovarian cancer (≥ stage III) and were admitted to an oncology hospital with inoperable malignant bowel obstruction between October 2016 and December 2017.…”

Section: Methodsmentioning

confidence: 99%

“…The benefit of HPN is that it can be administered outside of hospital allowing patients to be in their own environment. Although median survival lengths quoted in the literature vary from as little as 15 days for patients with cancer and palliative needs, it can be for substantial periods of time (9) . Some studies have reported these patients surviving on average more than 200 days on HPN (10) .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dealing with loss: food and eating in women with ovarian cancer on parenteral nutrition

Sowerbutts

Lal

Sremanakova

et al. 2020

J Human Nutrition Diet

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dealing with loss: food and eating in women with ovarian cancer on parenteral nutrition

Sowerbutts

Lal

Sremanakova

et al. 2020

J Human Nutrition Diet

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show abstract

“…Total parental nutrition (TPN), whilst a useful bridging tool for patients awaiting definitive solutions for enteral feeding, is not ideal for long-term use due to the potential for parenteralassociated liver disease, thrombophlebitis, and metabolic complications. It is well recognized that patients with esophageal cancer can struggle to maintain adequate nutrition through oral routes alone and that enteral feeding solutions can improve outcomes [3][4][5][6]. Multiple types of esophageal stents are available as palliative measures for malignant obstruction.…”

Section: Introductionmentioning

confidence: 99%

Retrograde Radiological Gastrostomy Technique and Retrograde Stent Placement in a Completely Occluded Cervical Esophagus

Bi¹,

Edwards²,

Mullan³

et al. 2021

Cureus

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Malignant obstruction of the cervical esophagus presents some anatomical and technical challenges when considering radiologic or endoscopic intervention. This case report describes the failure of antegrade access to place a gastrostomy tube and stent due to complete luminal occlusion from an esophageal tumor. The ultrasound-guided percutaneous gastric puncture was performed to achieve retrograde pneumodistension to allow radiologic gastrostomy insertion. Subsequently, the cervical esophagus was retrogradely cannulated via insertion of a guidewire from the gastrostomy site. A distal release esophageal stent was then inserted over the wire and deployed from the mouth in an antegrade manner.However, due to the unpredictable proximal shortening of distal release stents, this stent was eventually shortened and displaced so that it no longer covered the top of the tumor stricture, and further antegrade access failed. Once more, a retrograde access approach was adopted via the gastrostomy stoma, a guidewire and catheter were passed retrogradely through the original stent and out through the mouth. A distal release stent system was then inserted in a retrograde manner via the gastrostomy stoma, effectively making it a proximal release stent which enabled more precise positioning of the stent above the tumor. Palliation was achieved until death, and beyond expected mean survival.

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“…There are currently no standards of care/best clinical practice treatments for MBO 11–13. Although surgery is a potential option, its use often depends on a number of factors, such as a patient’s fitness for surgery, the anatomical level of obstruction and the extent of bowel involvement 8 11 14–18.…”

Section: Introductionmentioning

confidence: 99%

“…Further, the use of palliative systemic anticancer therapy may be associated with extended inpatient stay and treatment responses that are heavily reliant on the chemo-resistant nature of the residual tumour 9 10 16. Other therapeutic options used to support patients with MBO include laxatives, analgesia, anti-emetics, anti-secretive drugs and steroids as well as parenteral nutrition and low-fibre diets 12 18 24–26…”

Section: Introductionmentioning

confidence: 99%

Screening tool for malignant bowel obstruction in relapsed, metastatic ovarian cancer

et al. 2019

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BackgroundMalignant bowel obstruction (MBO) is a common cause of morbidity and mortality in women diagnosed with ovarian cancer. Earlier detection of MBO may improve patient outcomes. There are currently no screening tools to assist detection.AimWe report a screening questionnaire that can be used to detect MBO, and how the severity score for key clinical symptoms correlate with radiological evidence of MBO from ovarian cancer.DesignA case–control study in which patients with relapsed, metastatic ovarian cancer were asked to answer 10 questions related to key clinical symptoms associated with intestinal obstruction. The study group included women with CT-confirmed MBO, whereas the control group had no evidence of MBO. Patients scored each question according to severity from 1 (least severe) to 5 (most severe).Setting/participantsBetween 1 June and 31 December 2016, 37 women completed the screening questionnaire.ResultsPatients in the study group (n=17) reported significantly higher (ie, more severe) scores for abdominal pain, nausea, vomiting and constipation. In contrast, differences in severity scores between groups did not differ significantly in response to questions regarding abdominal swelling, borborygmi, diarrhoea or loss of appetite. All patients in the study group more frequently stated that their symptoms had deteriorated within the 2 months prior to completing the questionnaire.ConclusionHere we report the key clinical symptoms associated with radiologically-confirmed MBO in relapsed, metastatic ovarian cancer. We recommend healthcare practitioners focus on these specific symptoms during patient consultations in order to improve risk stratification of MBO.

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Home parenteral nutrition for people with inoperable malignant bowel obstruction

Abstract: This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of home parenteral nutrition in people with inoperable malignant bowel obstruction.

Cited by 17 publications

References 26 publications

Dealing with loss: food and eating in women with ovarian cancer on parenteral nutrition

Dealing with loss: food and eating in women with ovarian cancer on parenteral nutrition

Retrograde Radiological Gastrostomy Technique and Retrograde Stent Placement in a Completely Occluded Cervical Esophagus

Screening tool for malignant bowel obstruction in relapsed, metastatic ovarian cancer

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