Evidence-base Treatment for a Patient with Malignant Intestinal Obstruction_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Han , YUE Jirong , HOU YanBin ,  DENG JueLin

Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041 , China;

Corresponding author：

DENG JueLin, Email: juelind2005@yahoo.com.cn

Keywords：

Intestinal obstruction; Scopolamine; Octreotide; Treatment

DOI：

10.7507/1672-2531.20080013

Video：

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Objective　 We searched the best available evidence to provide a basis for the medical or palliative surgical treatment of a patient suffering from terminal colon cancer, complicated by intestinal obstruction (malignant intestinal obstruction), so as to improve the patient’s quality of life and alleviate her clinical symptoms.
Methods　 We formed the clinical question according to the PICO principle. We searched for systematic reviews and randomized controlled trials in The Cochrane Library (Issue 1, 2007), MEDLINE (PubMed, January 1950 to March 2007) and ACP Journal Club (January 1991 to March 2007), and evaluated the evidence retrieveds.?
Results　 We found that both scopolamine and octreotide could alleviate nausea, vomiting and abdominal pain, but that octreotide was superior to scopolamine in reducing the secretion of gastric acid. Metoclopramide was effective in relieving fatigue, vomiting and intestinal obstruction associated with advanced cancer. A nasogastric tube may be used to drain the secretions before the administration of medical treatment, but long-term use tubes may make patients intolerable and induced side effects, such as necrosis of nasal mucous membrane and infection. At present, empirical palliative surgery was used for the management of malignant intestinal obstruction. This varied in different regions, and so the patients’ clinical condition should be taken into consideration. Being informed of the advantages and disadvantages of different treatment regimens, the patient and her family made the final decision.
Conclusion　 The current evidence suggests that medical treatment can improve quality of life and alleviate clinical symptoms for a patient suffering from terminal colon cancer complicated with intestinal obstruction. However, the effect of palliative surgical treatment remains to be proved, and the decision about the appropriate treatment needs to consider the patients’ condition and the doctors’ clinical experiences.

Citation： WANG Han,YUE Jirong,HOU YanBin,DENG JueLin. Evidence-base Treatment for a Patient with Malignant Intestinal Obstruction. Chinese Journal of Evidence-Based Medicine, 2008, 08(1): 55-57. doi: 10.7507/1672-2531.20080013 Copy

1.	Mercadante S, Ripamonti C, Casuccio A, et al. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Support Care Cancer, 2000, 8(3): 188-191.
2.	Ripamonti C, Mercadante S, Groff L, et al. Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. J Pain Symptom Manage, 2000, 19(1): 23-34.
3.	Mystakidou K, Tsilika E, Kalaidopoulou O, et al. Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double-blind, controlled clinical trial.? Anticancer Res, 2002, 22(2B): 1187-1192.
4.	Zhang Y, Gao Y, Ma Q, et al. Randomised clinical trial investigating the effects of combined administration of octreotide and methylglucamine diatrizoate in the older persons with adhesive small bowel obstruction. Dig Liver Dis, 2006, 38(3): 188-194.
5.	Hardy J, Ling J, Mansi J, et al. Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction. Palliat Med, 1998, 12(6): 437-442.
6.	Laval G, Girardier J, Lassauniere JM, et al. The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction Palliat Med, 2000, 14(1): 3-10.
7.	Glare P, Pereira G, Kristjanson LJ, et al. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Support Care Cancer, 2004, 12(6): 432-440.
8.	Feuer DJ, Broadley KE. Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers. Ann Oncol, 1999, 10 (9): 1035-1041.
9.	Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (2).
10.	Mercadante S, Casuccio A, Mangione S, et al. Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review. J Pain Symptom Manage, 2007, 33(2): 217-223.
11.	Bruera E, Belzile M, Neumann C, et al. A double blind crossover study of controlled release metoclopramide and placebo for the chronic nausea and dyspepsia of advanced cancer. J Pain Symptom Manage, 2000, 19 (6): 427-435.
12.	Hardy J, Daly S, McQuade B, et al. A double blind, randomised parallel group, multi-national, multi-centre study comparing single dose ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg tds p.o. in the treatment of opioid induced nausea and emesis in cancer patients. Support Care Cancer, 2002, 10(2): 231-236.
13.	Pictus D, Marx MV, Weyman PJ. Chronic intestinal obstruction: value of percutaneous gastrostomy tube placement. Am J Roentgenol, 1988, 150 (2): 295-297.
14.	Feuer DJ, Broadley KE, Shepherd JH, et al. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (4).

1. Mercadante S, Ripamonti C, Casuccio A, et al. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Support Care Cancer, 2000, 8(3): 188-191.
2. Ripamonti C, Mercadante S, Groff L, et al. Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. J Pain Symptom Manage, 2000, 19(1): 23-34.
3. Mystakidou K, Tsilika E, Kalaidopoulou O, et al. Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double-blind, controlled clinical trial.? Anticancer Res, 2002, 22(2B): 1187-1192.
4. Zhang Y, Gao Y, Ma Q, et al. Randomised clinical trial investigating the effects of combined administration of octreotide and methylglucamine diatrizoate in the older persons with adhesive small bowel obstruction. Dig Liver Dis, 2006, 38(3): 188-194.
5. Hardy J, Ling J, Mansi J, et al. Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction. Palliat Med, 1998, 12(6): 437-442.
6. Laval G, Girardier J, Lassauniere JM, et al. The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction Palliat Med, 2000, 14(1): 3-10.
7. Glare P, Pereira G, Kristjanson LJ, et al. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Support Care Cancer, 2004, 12(6): 432-440.
8. Feuer DJ, Broadley KE. Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers. Ann Oncol, 1999, 10 (9): 1035-1041.
9. Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (2).
10. Mercadante S, Casuccio A, Mangione S, et al. Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review. J Pain Symptom Manage, 2007, 33(2): 217-223.
11. Bruera E, Belzile M, Neumann C, et al. A double blind crossover study of controlled release metoclopramide and placebo for the chronic nausea and dyspepsia of advanced cancer. J Pain Symptom Manage, 2000, 19 (6): 427-435.
12. Hardy J, Daly S, McQuade B, et al. A double blind, randomised parallel group, multi-national, multi-centre study comparing single dose ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg tds p.o. in the treatment of opioid induced nausea and emesis in cancer patients. Support Care Cancer, 2002, 10(2): 231-236.
13. Pictus D, Marx MV, Weyman PJ. Chronic intestinal obstruction: value of percutaneous gastrostomy tube placement. Am J Roentgenol, 1988, 150 (2): 295-297.
14. Feuer DJ, Broadley KE, Shepherd JH, et al. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (4).

Chinese Journal of Evidence-Based Medicine

Evidence-base Treatment for a Patient with Malignant Intestinal Obstruction

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