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Malignant bowel obstruction

Key sources
The following summarized guidelines for the management of malignant bowel obstruction are prepared by our editorial team based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC 2022), the European Society of Medical Oncology (ESMO 2021), the American Gastroenterological Association (AGA 2021), the Multinational Association of Supportive Care in Cancer (MASCC/ESMO 2016), and the Eastern Association for the Surgery of Trauma (EAST 2016).
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Guidelines

1.Medical management

Antiemetics: as per MASCC 2022 guidelines, consider administering octreotide to reduce vomiting in patients with MBO.
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  • Laxatives

  • Corticosteroids

  • Opioids

  • Anticholinergics

  • Water-soluble contrast agents

2.Nonpharmacologic interventions

Nutrition: keep the patient NPO initially when diagnosed with MBO, and then switch to a symptom-led, slow and graded reintroduction to oral diet when acute MBO resolves fully or partially, including clear fluids, free or full fluids, texture-modified low-fiber diet (soft, minced, and pureed) and if tolerated back to normal-textured low-fiber diet.
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3.Therapeutic procedures

General principles: decide on specific interventions in patients with alimentary tract obstruction in a multidisciplinary setting including oncologists, surgeons and endoscopists and take into account the characteristics of the obstruction, patient's expectations, prognosis, expected subsequent therapies and functional status.
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  • Bowel decompression

  • Self-expanding metallic stents

4.Surgical interventions

Palliative surgery
As per MASCC 2022 guidelines:
Consider performing palliative surgical intervention in highly selected patients with a multi-level obstruction.
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Consider performing less invasive surgical interventions in patients with advanced cancer undergoing palliative surgery for MBO because of high risk of surgical complications.
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