Medical Treatment for Inoperable Malignant Bowel Obstruction: A Qualitative Systematic Review

Abstract

The use of symptomatic agents has greatly improved the medical treatment of advanced cancer patients with inoperable bowel obstruction. A systematic review of studies of the most popular drugs used in the medical management of inoperable malignant bowel obstruction was performed to assess the effectiveness of these treatments and provide some lines of evidence. Randomized trials that involved patients with a clinical diagnosis of intestinal obstruction due to advanced cancer treated with these drugs were reviewed. Five reports fulfilled inclusion criteria. Three studies compared octreotide (OC) and hyoscine butylbromide (HB), and two studies compared corticosteroids (CSs) and placebo. Globally, 52 patients received OC, 51 patients received HB, 37 patients received CSs, 15 patients received placebo, and 37 patients received both placebo and CSs. On the basis of these few data, the superiority of OC over HB in relieving gastrointestinal symptoms was evidenced in a total of 103 patients. The latter studies had samples more defined in terms of stage and inoperability, and had a shorter survival in comparison with studies of CSs (less than 61 days, most of them less than 20 days). Data on CSs are less convincing, due to the methodological weakness of existing studies. This review confirms the difficulties in conducting randomized controlled trials in this population. J Pain Symptom Manage 2007;33:217e223.

Clinical Impact of Palliative Treatment Using Octreotide for Inoperable Malignant Bowel Obstruction Caused by Advanced Urological Cancer

“…The efficacy of octreotide in controlling the symptoms of MBO has been shown in several reports (Davis and Nouneh, 2000;Ripamonti and Mercadante, 2005;Mercadante et al, 2007;O'Connor and Creedon, 2011;Mercadante and Porzio, 2012).…”

“…Octreotide also suppresses the secretion of digestive fluids and promotes water and electrolyte absorption. These effects of octreotide lead to alleviation of MBO symptoms by limiting the vicious cycle of distention and secretion (Khoo et al, 1994;Ripamonti and Mercadante, 2005;Mercadante et al, 2007;Mercadante and Porzio, 2012). The efficacy of octreotide in MBO management has been frequently reported in gastrointestinal and ovarian cancers, but not in urological cancer Mystakidou et al, 2002;Mercadante et al, 2004).…”

“…However, the effects of octreotide and corticosteroids on MBO have not been compared. Further research is needed to examine the role of corticosteroids in MBO treatment (Mercadante et al, 2007;O'Connor and Creedon, 2011). Combination therapy of octreotide and corticosteroids has been studied empirically, but there is not enough data to support its efficacy.…”

Role of Steroids in Malignant Bowel Obstruction

“…Intestinal transit also improves because of decreased perineural edema and thus has bimodal benefit of both symptomatic relief and reduction in obstruction. 10 Thus, steroids hasten resolution of MBO and shorten length of hospital stay. Their general effect includes improved appetite, mood and strength as well.…”

Radiological imaging change in a malignant bowel obstruction patient treated with octreotide

“…The efficacy of octreotide, a synthetic analogue of somatostatin, has been established to manage MBO related symptoms with randomized controlled trials. These researches revealed octreotide was superior to hyoscine butylbromide for physical symptom alleviation (nausea, vomiting, pain, fatigue anorexia, dry mouth, abdominal distension, and drowsiness) or nasogastric tube removal [5,6,7,12]. To our knowledge, the mechanism that octreotide increase water absorption in case of MBO has not been demonstrated except for experimental animal and normal human model [2,3].…”