Role of Steroids in Malignant Bowel Obstruction

Patel, Anuradha; Garg, Rakesh

doi:10.17140/pmhcoj-2-116

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…The use of corticosteroids in palliative therapy is not novel and has been prescribed as part of palliative management for patients with advanced malignancy since the 1950s for its central antiemetic, anti-inflammatory, antisecretory, and analgesic effects. 15 mSBO can be caused by bowel-occlusive intramural infiltration, extrinsic compression of the bowel, functional motility disorders, or side effects of radiotherapy due to stricture and negative impact on peristalsis. 19 Common pathophysiology to each process is the accumulation of fluid and gases via a cascade of inflammatory mediator release.…”

Section: Discussionmentioning

confidence: 99%

“…19 Common pathophysiology to each process is the accumulation of fluid and gases via a cascade of inflammatory mediator release. 15 , 20 It is thought that steroids target the inflammatory mediator cascade and may be a potential treatment for mSBO by decreasing gut wall edema, peritoneal inflammation, and inflammation in proximity to the obstruction while indirectly decreasing pain via relief of luminal obstruction. 15 , 21 …”

Section: Discussionmentioning

confidence: 99%

“… 13 , 14 Therefore, there is a significant interest in optimizing adjunct nonoperative measures to manage mSBO, specifically corticosteroid use. 15 …”

Section: Introductionmentioning

confidence: 99%

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Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction

Yang,

Serrano,

Bilodeau

et al. 2024

Annals of Surgery Open

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Objective: To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes. Background: mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible. The use of dexamethasone to restore bowel function is recommended in the National Comprehensive Cancer Network guidelines for mSBO. Yet, it is unknown how often dexamethasone is used for mSBO and whether results from nonresearch settings support its use. Methods: This is a multicenter retrospective cohort study including unique admissions for mSBO from January 1, 2019 to December 31, 2021. Dexamethasone use and management outcomes were summarized with descriptive statistics and multiple logistic regression. Results: Among 571 admissions (68% female, mean age 63 years, 85% history of abdominal surgery) that were eligible and initially nonoperative, 26% [95% confidence interval (CI) = 23%–30%] received dexamethasone treatment (69% female, mean age 62 years, 87% history of abdominal surgery). Dexamethasone use by site ranged from 13% to 52%. Among dexamethasone recipients, 13% (95% CI = 9%–20%) subsequently required nonelective surgery during the same admission and 4 dexamethasone-related safety-events were reported. Amongst 421 eligible admissions where dexamethasone was not used, 17% (95% CI = 14%–21%) required nonelective surgery. Overall, the unadjusted odds ratio (OR) for nonelective surgery with dexamethasone use compared to without its use was 0.7 (95% CI = 0.4–1.3). Using multiple logistic regression, OR after adjusting for site, age, sex, history of abdominal surgery, nasogastric tube, and Gastrografin use was 0.6 (95% CI = 0.3–1.1). Conclusion: Dexamethasone was used in about 1 in 4 eligible mSBO admissions with high variability of use between tertiary academic centers. This multicenter retrospective cohort study suggested an association between dexamethasone use and lower rates of nonelective surgery, representing a potential opportunity for quality improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction

Yang,

Serrano,

Bilodeau

et al. 2024

Annals of Surgery Open

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The holistic management of malignant bowel obstruction in women with advanced ovarian cancer at end of life

Gaughan

Williams

2023

Br J Nurs

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Bowel obstruction is commonly a pre-terminal event in women with advanced ovarian cancer. Management of symptoms will often be the focus rather than surgical intervention. Determining the patient's end-of-life wishes is paramount − because the prognosis for these patients can be short, advanced care planning is key. This case study will explore the management of nausea and vomiting associated with malignant bowel obstruction and demonstrate how a patient's psychological and social wellbeing is as important as managing the physical symptoms. It will discuss how skilled and effective communication is vital early in the disease trajectory in ensuring the patient's needs are met. Additionally, by undertaking a thorough holistic needs assessment, all aspects of end-of-life care can be discussed with the patient and family, which may enable the achievement of a preferred place of care and a peaceful, dignified death. Multidisciplinary working and co-ordination of care may allow for quick interventions, meeting individual needs and symptoms being managed more effectively.

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Role of Steroids in Malignant Bowel Obstruction

Cited by 2 publications

References 17 publications

Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction

Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction

The holistic management of malignant bowel obstruction in women with advanced ovarian cancer at end of life

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