The Role of Somatostatin and Octreotide in Bowel Obstruction: Pre-Clinic Al and Clinical Results

Abstract

Malignant bowel obstruction is a common complication in patients with advanced abdominal or pelvic cancer. Whereas surgery should be considered in all cases of malignant bowel obstruction, many advanced and terminal cancer patients are considered unfit for surgery. In such patients with a short life expectancy, gastrointestinal symptoms such as nausea, vomiting, continuous and/or colicky pain, can be controlled by using a pharmacologic approach made up of analgesics, antiemetics and antisecretory drugs, without the use of a venting nasogastric tube. Among the antisecretory drugs, octreotide has been shown to reduce nausea and vomiting in bowel-obstructed patients owing to a reduction of gastrointestinal secretions, thus allowing in most patients removal of the nasogastric tube and the associated distress. Preclinical and clinical studies that demonstrated the role of somatostatin and octreotide in bowel obstruction are reviewed.

Current concepts in malignant bowel obstruction management

“…Obstruction leads to four pathophysiologic processes: 1) accumulation of gastric, pancreatic, and biliary secretions that act as potent stimuli for further intestinal secretions proximal to the obstruction site; 2) decreased absorption of water and sodium in the intestinal lumen; 3) increased secretion of water and sodium into the lumen as distention increases [8]; and 4) infl ammatory tumor response in and around the bowel wall, exacerbating fl uid secretion and obstructive physiology [5,9]. As the GI secretions accumulate in the bowel and the reabsorption process fails, the bowel continues to lose fl uids and electrolytes, and a vicious cycle of distention-secretiondistention results (Fig.…”

Surgical Treatment in Palliative Care

“…The subcutaneous injection of octreotide analogues (e.g. Sandostatin™) effectively reduces intraluminal secretion, alleviating the symptoms of bowel obstruction [ 50 ]. Other drugs, such as morphine, haloperidol, and butylscopolamine, are important supplements and may be given together as a continuous subcutaneous infusion.…”

“You Wanna Do What?!” Modern Indications for Nasogastric Intubation

“…In mild obstruction-where pain, distention, and the risk of perforation are minor-NGI offers less benefit. Patients with metastatic intra-abdominal cancer and obstruction, when treated medically with ocreotide with or without somatostatin or scopolamine, have safely avoided NGI (12,13). Also, in isolated colonic distension, where the large bowel dilatates distal to a competent ileocecal valve, NGI may not be useful.…”